Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course...

Area of Science:

• Urology
• Oncology
• Prostate Cancer Management

Background:

• Active surveillance is a management option for low-risk localized prostate cancer.
• Biopsy re-evaluation during active surveillance can lead to Gleason score upgrades.

Purpose of the Study:

• To assess outcomes for patients with low-risk prostate cancer experiencing a Gleason score upgrade during active surveillance.
• To determine if delayed treatment after an upgrade is associated with adverse pathological outcomes.

Main Methods:

• Retrospective analysis of 219 men with low-risk prostate cancer initially on active surveillance who were upgraded (Gleason 3+4 or greater).
• Kaplan-Meier curves for treatment-free survival; Cox and logistic regression for factors associated with treatment and adverse outcomes.
• Comparison of initial biopsy and surgical pathology findings.

Main Results:

• 150 men (68%) upgraded to 3+4, 69 (32%) to 4+3 or greater; median upgrade time 23 months.
• 74% opted for treatment, primarily radical prostatectomy.
• 5-year treatment-free survival: 22% for 3+4, 10% for 4+3+ upgrade. Upgrade to 4+3+, PSA density, and shorter time to upgrade predicted treatment.
• 34% downgraded, 6% upgraded at surgery. Initial tumor volume associated with adverse pathology (OR 3.33, p=0.02).

Conclusions:

• Most patients with Gleason score upgrade on active surveillance elect for radical prostatectomy.
• Few patients who defer treatment experience further significant upgrading.
• Initial tumor volume is a key predictor of adverse pathological outcomes upon radical prostatectomy.