The aim of this study was to evaluate the feasibility of including patients with biopsy Gleason score (bGS) 3 + 4 prostate cancer in an active surveillance (AS) protocol.
A total of 615 patients underwent a radical prostatectomy and satisfied the following requirements: prostate-specific antigen ≤10 ng/dL, clinical stage T1c or T2a, 2 or fewer positive biopsy cores, and bGS 6 or 3 + 4 prostate cancer. The patients were divided into two groups according to their bGS (bGS 6 group, n =534; bGS 3 + 4 group, n = 81).
The adverse pathological features were significantly higher in the bGS 3 + 4 group (16.7 vs. 49.4%, p< 0.001). Biochemical recurrence (BCR)-free survival was also significantly lower in this group (p < 0.001). In a multivariate analysis, clinical stage (odds ratio [OR] 2.026, p =0.007), maximum percentage of biopsy core involvement (OR 1.015, p = 0.014), and bGS (OR 1.913, p = 0.030) were independent risk factors for adverse pathological features. However, the bGS was the only variable to forecast BCR (hazard ratio 3.567, p < 0.001).
A bGS 3 + 4 was the leading risk factor for a worse postoperative prognosis. Therefore, patients with a bGS 3 + 4 are not appropriate candidates for AS.
Urologia internationalis. 2019 Nov 06 [Epub ahead of print]
Juhyun Park, Sangjun Yoo, Min Chul Cho, Chang Wook Jeong, Ja Hyeon Ku, Cheol Kwak, Hyeon Hoe Kim, Hyeon Jeong
Department of Urology, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, Seoul, Republic of Korea., Department of Urology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea., Department of Urology, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, Seoul, Republic of Korea, .