1039 Contemporary patients with biopsy Gleason 3+4 prostate cancer: Eligibility for active surveillance

Abstract

INTRODUCTION AND OBJECTIVES: We analyzed whether expansion of existing active surveillance (AS) protocols to include men with biopsy Gleason score (GS) 3þ4 prostate cancer (PCa) would significantly alter pathologic and biochemical outcomes of potential candidates of AS. METHODS: Among patients who underwent radical prostatectomy at our center between 2006 and 2013, we identified 577 patients (group A) who preoperatively fulfilled at least one of 6 different AS criteria. Also, we identified 217 patients (group B) with biopsy GS 3þ4 but fulfilled non-GS criteria from at least one of 6 AS criteria. Designating group C as expanded group incorporating all patients in group A and B, we compared risk of unfavorable disease (pathologic GS 4þ3 and/or pathologic T stage pT3a) and biochemical recurrence (BCR)free survival between groups. RESULTS: Rates of unfavorable disease were not significantly different between patients of group A and C who met AS criteria from 5 institutions (all p> 0.05), not including University of Toronto (p 0.05). Among group B, PSAD >0.15 ng/mL/cm3 (p1⁄4 0.011) and tumor length of biopsy GS 3þ4 core > 4 mm (p1⁄4 0.007) were significant predictors of unfavorable disease. When these two criteria were newly applied in defining group B, rates of unfavorable disease in group A and B was 15.6% and 14.7%, respectively (p1⁄4 0.886). CONCLUSIONS: Overall rate of pathologically aggressive PCa harbored by potential candidates for AS may not be increased significantly with expansion of criteria to biopsy GS 3þ4 under most contemporary AS protocols. PSAD and tumor length of biopsy GS 3þ4 core may be useful predictors of more aggressive disease among potential candidates for AS with biopsy GS 3þ4.