Effects of Initial Gleason Grade on Outcomes during Active Surveillance for Prostate Cancer

Selma Masic, Janet E Cowan, Samuel L Washington, Hao G Nguyen, Katsuto Shinohara, Matthew R Cooperberg, Peter R Carroll
European Urology Oncology 2018, 1 (5): 386-394

BACKGROUND: Whether men with Gleason 3+4 prostate cancer are appropriate active surveillance (AS) candidates remains a matter of debate.

OBJECTIVE: to evaluate the effects of initial Gleason grade 3+3 or 3+4 on clinical outcomes during AS.

DESIGN, SETTING, AND PARTICIPANTS: We retrospectively reviewed outcomes for men on AS between 1990 and 2016 with Gleason 3+3 or 3+4 who had two or more biopsies.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We evaluated associations of diagnostic grade with reclassification (upgrade ≥ 3+4), treatment, metastasis, adverse surgical pathology, and biochemical recurrence (BCR) after deferred radical prostatectomy (RP), with a sensitivity analysis for the amount of pattern 4 disease.

RESULTS AND LIMITATIONS: Of 1243 men, 1119 (90%) had Gleason 3+3 and 124 (10%) 3+4 on initial biopsy. The 5-yr unadjusted reclassification-free survival was 49% regardless of grade, while patients with Gleason 3+4 had lower treatment-free survival (49% vs 64%; p<0.01). On multivariate Cox analysis, grade was associated with lower risk of reclassification (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.46-0.95) and higher risk of treatment (HR 1.37, 95% CI 1.01-1.85). After RP, patients starting with Gleason 3+4 had lower unadjusted 2-yr BCR-free survival (69% vs 93%; p=0.01) and a higher risk of recurrence (HR 3.67, 95% CI 1.30-10.36). Grade was not associated with metastasis (<1% at 5 yr) or adverse pathology. In sensitivity analyses, a single high-grade core was associated with lower risk of reclassification and multiple high-grade cores were associated with a higher risk of treatment. The number of high-grade cores was not independently associated with BCR. Limitations include selection bias, a limited number of intermediate-risk patients, and length of follow-up.

CONCLUSIONS: Gleason 3+4 at diagnosis was associated with risk of reclassification, treatment, and BCR. The number of high-grade cores may help in stratifying men with Gleason 3+4 disease.

PATIENT SUMMARY: Some men with Gleason 3+4 prostate cancer may be appropriate surveillance candidates, but longer follow-up and evaluation of more patients are necessary.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"