Active Surveillance May Be Safe for Selected Men With Gleason 3+4 Prostate Cancer

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Men with Gleason 6 and Gleason 3+4 prostate cancer who undergo radical prostatectomy after a period on active surveillance have similar surgical outcomes.
Men with Gleason 6 and Gleason 3+4 prostate cancer who undergo radical prostatectomy after a period on active surveillance have similar surgical outcomes.

New findings support the safety of including selected men with Gleason 3+4 prostate cancer in active surveillance (AS) programs, Australian researchers reported at the American Urological Association 2018 annual meeting.

Using a prospective AS database, Arveen Kalapara, of Monash University in Melbourne, and colleagues analyzed the records of 359 patients who underwent delayed radical prostatectomy (RP) after a period of AS from 2001 to 2017. The men underwent confirmatory biopsy at 1 year and subsequent surveillance biopsies. Of these men, 286 commenced AS with Gleason score (GS) 6 disease and 73 with GS 3+4 disease; 109 (38.1%) and 38 (52.1%) progressed to treatment, respectively.

Men who underwent RP were divided into 2 groups. Group A included men who started AS with GS 6 disease and had RP immediately after upgrading to Gleason score 7 or higher, or after remaining as Gleason score 6. Group B included men with GS 3+4 disease, or those with Gleason score 6 disease who progressed to Gleason score 3+4 but then remained on AS prior to RP.

Groups A and B were similar with respect to mean age (61.6 vs 63 years), PSA level at diagnosis (6.6 vs 5.7 ng/mL), and time to progression (27.8 vs 28.2 months). The investigators found no significant difference between groups A and B in the proportion of men with unfavorable disease, defined as Gleason score 4+3 disease or higher or stage pT3 disease (54.5% vs 52.5%), and in the rates of biochemical recurrence (15.6% vs. 15%).

Reference

  1. Kalapara A, Landau A, Fahey M, et al. Surgical outcomes of men with localized leason 3+4 prostate cancer on active surveillance in an Australian population. Data presented in poster format at the American Urological Association 2018 annual meeting, San Francisco, May 18–21. Abstract MP17-08.

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