AS 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.
The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2018. 

SAN FRANCISCO—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%).

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Reference

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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