Favorable Gleason 3 + 4 Prostate Cancer Shows Comparable Outcomes With Gleason 3 + 3 Prostate Cancer: Implications for the Expansion of Selection Criteria for Active Surveillance

Hakmin Lee, In Jae Lee, Seok Soo Byun, Sang Eun Lee, Sung Kyu Hong

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2 Citations (Scopus)

Abstract

Micro-Abstract To evaluate the feasibility of active surveillance in patients with biopsy Gleason score (GS) 3 + 4 prostate cancer, GS 3 + 4 patients with favorable profiles were compared to GS 3 + 3 patients. After analyzing 1491 subjects, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes compared to GS 3 + 3 patients. Background To investigate the feasibility of active surveillance (AS) in biopsy Gleason score (GS) 3 + 4 prostate cancer (PCa), we compared the outcomes of biopsy GS 3 + 3 and 3 + 4 PCa after radical prostatectomy. Patients and Methods We analyzed the data of 1491 patients undergoing radical prostatectomy for biopsy GS 3 + 3 or 3 + 4 PCa who fulfilled the low-risk criteria of the National Comprehensive Cancer Network guidelines regardless of GS. The favorable GS 3 + 4 group was defined as having core involvement ≤ 50%, prostate-specific antigen density ≤ 0.2 ng/mL/cm3, and number of positive cores ≤ 2 (maximal 1 core of GS 3 + 4). Results The GS 3 + 4 group showed significantly worse pathologic outcomes, including pathologic GS, pathologic stage, and seminal vesicle invasion rate (all P <.001), as well as worse biochemical recurrence–free survival (P <.001) than the GS 3 + 3 group. However, the favorable GS 3 + 4 subgroup showed no significant differences in the pathologic outcomes (all P >.05) and in biochemical recurrence–free survival (P =.817) compared to the GS 3 + 3 group. Conclusion Despite the application of low-risk criteria, GS 3 + 4 PCa patients showed significantly worse outcomes than GS 3 + 3 patients. However, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes with GS 3 + 3 patients, suggesting possible expansion of AS for the favorable GS 3 + 4 group.

Original languageEnglish
Pages (from-to)e1117-e1122
JournalClinical Genitourinary Cancer
Volume15
Issue number6
DOIs
StatePublished - Dec 2017

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Neoplasm Grading
Patient Selection
Prostatic Neoplasms
Biopsy
Prostatectomy
Seminal Vesicles

Keywords

  • Active surveillance
  • Biopsy
  • Gleason score
  • Prostate cancer
  • Prostatectomy

Cite this

@article{0b06b6a135654f4fac72b6b845d67752,
title = "Favorable Gleason 3 + 4 Prostate Cancer Shows Comparable Outcomes With Gleason 3 + 3 Prostate Cancer: Implications for the Expansion of Selection Criteria for Active Surveillance",
abstract = "Micro-Abstract To evaluate the feasibility of active surveillance in patients with biopsy Gleason score (GS) 3 + 4 prostate cancer, GS 3 + 4 patients with favorable profiles were compared to GS 3 + 3 patients. After analyzing 1491 subjects, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes compared to GS 3 + 3 patients. Background To investigate the feasibility of active surveillance (AS) in biopsy Gleason score (GS) 3 + 4 prostate cancer (PCa), we compared the outcomes of biopsy GS 3 + 3 and 3 + 4 PCa after radical prostatectomy. Patients and Methods We analyzed the data of 1491 patients undergoing radical prostatectomy for biopsy GS 3 + 3 or 3 + 4 PCa who fulfilled the low-risk criteria of the National Comprehensive Cancer Network guidelines regardless of GS. The favorable GS 3 + 4 group was defined as having core involvement ≤ 50{\%}, prostate-specific antigen density ≤ 0.2 ng/mL/cm3, and number of positive cores ≤ 2 (maximal 1 core of GS 3 + 4). Results The GS 3 + 4 group showed significantly worse pathologic outcomes, including pathologic GS, pathologic stage, and seminal vesicle invasion rate (all P <.001), as well as worse biochemical recurrence–free survival (P <.001) than the GS 3 + 3 group. However, the favorable GS 3 + 4 subgroup showed no significant differences in the pathologic outcomes (all P >.05) and in biochemical recurrence–free survival (P =.817) compared to the GS 3 + 3 group. Conclusion Despite the application of low-risk criteria, GS 3 + 4 PCa patients showed significantly worse outcomes than GS 3 + 3 patients. However, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes with GS 3 + 3 patients, suggesting possible expansion of AS for the favorable GS 3 + 4 group.",
keywords = "Active surveillance, Biopsy, Gleason score, Prostate cancer, Prostatectomy",
author = "Hakmin Lee and Lee, {In Jae} and Byun, {Seok Soo} and Lee, {Sang Eun} and Hong, {Sung Kyu}",
year = "2017",
month = "12",
doi = "10.1016/j.clgc.2017.07.020",
language = "English",
volume = "15",
pages = "e1117--e1122",
journal = "Clinical Genitourinary Cancer",
issn = "1558-7673",
publisher = "Elsevier",
number = "6",

}

TY - JOUR

T1 - Favorable Gleason 3 + 4 Prostate Cancer Shows Comparable Outcomes With Gleason 3 + 3 Prostate Cancer

T2 - Implications for the Expansion of Selection Criteria for Active Surveillance

AU - Lee, Hakmin

AU - Lee, In Jae

AU - Byun, Seok Soo

AU - Lee, Sang Eun

AU - Hong, Sung Kyu

PY - 2017/12

Y1 - 2017/12

N2 - Micro-Abstract To evaluate the feasibility of active surveillance in patients with biopsy Gleason score (GS) 3 + 4 prostate cancer, GS 3 + 4 patients with favorable profiles were compared to GS 3 + 3 patients. After analyzing 1491 subjects, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes compared to GS 3 + 3 patients. Background To investigate the feasibility of active surveillance (AS) in biopsy Gleason score (GS) 3 + 4 prostate cancer (PCa), we compared the outcomes of biopsy GS 3 + 3 and 3 + 4 PCa after radical prostatectomy. Patients and Methods We analyzed the data of 1491 patients undergoing radical prostatectomy for biopsy GS 3 + 3 or 3 + 4 PCa who fulfilled the low-risk criteria of the National Comprehensive Cancer Network guidelines regardless of GS. The favorable GS 3 + 4 group was defined as having core involvement ≤ 50%, prostate-specific antigen density ≤ 0.2 ng/mL/cm3, and number of positive cores ≤ 2 (maximal 1 core of GS 3 + 4). Results The GS 3 + 4 group showed significantly worse pathologic outcomes, including pathologic GS, pathologic stage, and seminal vesicle invasion rate (all P <.001), as well as worse biochemical recurrence–free survival (P <.001) than the GS 3 + 3 group. However, the favorable GS 3 + 4 subgroup showed no significant differences in the pathologic outcomes (all P >.05) and in biochemical recurrence–free survival (P =.817) compared to the GS 3 + 3 group. Conclusion Despite the application of low-risk criteria, GS 3 + 4 PCa patients showed significantly worse outcomes than GS 3 + 3 patients. However, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes with GS 3 + 3 patients, suggesting possible expansion of AS for the favorable GS 3 + 4 group.

AB - Micro-Abstract To evaluate the feasibility of active surveillance in patients with biopsy Gleason score (GS) 3 + 4 prostate cancer, GS 3 + 4 patients with favorable profiles were compared to GS 3 + 3 patients. After analyzing 1491 subjects, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes compared to GS 3 + 3 patients. Background To investigate the feasibility of active surveillance (AS) in biopsy Gleason score (GS) 3 + 4 prostate cancer (PCa), we compared the outcomes of biopsy GS 3 + 3 and 3 + 4 PCa after radical prostatectomy. Patients and Methods We analyzed the data of 1491 patients undergoing radical prostatectomy for biopsy GS 3 + 3 or 3 + 4 PCa who fulfilled the low-risk criteria of the National Comprehensive Cancer Network guidelines regardless of GS. The favorable GS 3 + 4 group was defined as having core involvement ≤ 50%, prostate-specific antigen density ≤ 0.2 ng/mL/cm3, and number of positive cores ≤ 2 (maximal 1 core of GS 3 + 4). Results The GS 3 + 4 group showed significantly worse pathologic outcomes, including pathologic GS, pathologic stage, and seminal vesicle invasion rate (all P <.001), as well as worse biochemical recurrence–free survival (P <.001) than the GS 3 + 3 group. However, the favorable GS 3 + 4 subgroup showed no significant differences in the pathologic outcomes (all P >.05) and in biochemical recurrence–free survival (P =.817) compared to the GS 3 + 3 group. Conclusion Despite the application of low-risk criteria, GS 3 + 4 PCa patients showed significantly worse outcomes than GS 3 + 3 patients. However, favorable GS 3 + 4 patients showed comparable clinicopathologic outcomes with GS 3 + 3 patients, suggesting possible expansion of AS for the favorable GS 3 + 4 group.

KW - Active surveillance

KW - Biopsy

KW - Gleason score

KW - Prostate cancer

KW - Prostatectomy

UR - http://www.scopus.com/inward/record.url?scp=85028342126&partnerID=8YFLogxK

U2 - 10.1016/j.clgc.2017.07.020

DO - 10.1016/j.clgc.2017.07.020

M3 - Article

C2 - 28843377

AN - SCOPUS:85028342126

VL - 15

SP - e1117-e1122

JO - Clinical Genitourinary Cancer

JF - Clinical Genitourinary Cancer

SN - 1558-7673

IS - 6

ER -