Abstract
Background
To investigate the feasibility of active surveillance (AS) in biopsy Gleason score
(GS) 3 + 4 prostate cancer (PCa), we compared the outcomes of biopsy GS 3 + 3 and
3 + 4 PCa after radical prostatectomy.
Patients and Methods
We analyzed the data of 1491 patients undergoing radical prostatectomy for biopsy
GS 3 + 3 or 3 + 4 PCa who fulfilled the low-risk criteria of the National Comprehensive
Cancer Network guidelines regardless of GS. The favorable GS 3 + 4 group was defined
as having core involvement ≤ 50%, prostate-specific antigen density ≤ 0.2 ng/mL/cm3, and number of positive cores ≤ 2 (maximal 1 core of GS 3 + 4).
Results
The GS 3 + 4 group showed significantly worse pathologic outcomes, including pathologic
GS, pathologic stage, and seminal vesicle invasion rate (all P < .001), as well as worse biochemical recurrence–free survival (P < .001) than the GS 3 + 3 group. However, the favorable GS 3 + 4 subgroup showed
no significant differences in the pathologic outcomes (all P > .05) and in biochemical recurrence–free survival (P = .817) compared to the GS 3 + 3 group.
Conclusion
Despite the application of low-risk criteria, GS 3 + 4 PCa patients showed significantly
worse outcomes than GS 3 + 3 patients. However, favorable GS 3 + 4 patients showed
comparable clinicopathologic outcomes with GS 3 + 3 patients, suggesting possible
expansion of AS for the favorable GS 3 + 4 group.
Keywords
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Article info
Publication history
Published online: August 02, 2017
Accepted:
July 27,
2017
Received in revised form:
July 24,
2017
Received:
April 10,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
