To examine the feasibility of active surveillance for low volume Gleason sum (GS) 3 + 4 disease compared to GS 3 + 3 disease.
Retrospective review of 929 patients, with biopsy proven GS 3 + 3 and 3 + 4 PCa, undergoing upfront radical prostatectomy (RP) was performed.
Suitability for AS was adapted from protocols by Royal Marsden Hospital, University of Toronto, and PRIAS by allowing Gleason 3 + 4 disease. The outcomes assessed were adverse pathology at RP (upgrading ≥GS 4 + 3 and/or upstaging ≥pT3) and biochemical recurrence (BCR) after RP.
Adverse pathology at RP was compared between GS 3 + 3 vs 3 + 4 groups. When selecting patients using Royal Marsden (n = 714) or University of Toronto (n = 699) protocols, there was statistically significantly more adverse pathology at RP in GS 3 + 4 group (21% vs 31%, P = 0.0028 and 19% vs 33%, P=<0.001 respectively). Using the more stringent PRIAS protocol (n = 198), there was no statistical significant difference in groups. There was no difference in BCR survival between biopsy GS 3 + 3 and 3 + 4 groups, regardless of which AS protocol assessed. Pre-operative PSA and clinical staging were the predictors for BCR.
Presence of Gleason 3 + 4 at biopsy, when compared to 3 + 3, increases the risk of adverse pathology being present at radical prostatectomy for less stringent selection criteria. When considering AS, a stricter protocol such as PRIAS, limiting PSA density and number of positive cores to ≤2, appears to decrease the risk of adverse pathology. No differences in BCR were seen between biopsy 3 + 3 and 3 + 4 disease, regardless of AS selection criteria.
BJU international. 2016 Apr [Epub]
Lih-Ming Wong, Vincent Tang, Justin Peters, Anthony Costello, Niall Corcoran
The Australian Prostate Cancer Centre at Epworth and Departments of Urology and Surgery, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., The Australian Prostate Cancer Centre at Epworth and Departments of Urology and Surgery, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., The Australian Prostate Cancer Centre at Epworth and Departments of Urology and Surgery, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., The Australian Prostate Cancer Centre at Epworth and Departments of Urology and Surgery, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia., The Australian Prostate Cancer Centre at Epworth and Departments of Urology and Surgery, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia.