Active surveillance (AS) is an appropriate option for patients diagnosed with Gleason Grade Group (GG) 2 prostate cancer, according to new data presented at the virtual 2021 Genitourinary Cancers Symposium.

Of 98 mostly White patients (mean age 64 years) with GG2 (Gleason score 3+4) prostate cancer enrolled in AS at the National Institutes of Health (NIH) in Bethesda, Maryland, 36 patients (37%) progressed to GG3 or higher disease at a median of 71 months, Jillian Egan, MD, and colleagues from the National Cancer Institute reported. The median PSA level at progression was significantly higher than at baseline: 8.5 vs 5.2 ng/mL. The median PSA density was also significantly elevated at progression (0.13 vs 0.12 ng/mL/cc). The highest PIRADS score on magnetic resonance imaging (MRI) did not change, however.

The majority of patients progressed to GG3 disease (Gleason score 4+3), with progression the trigger for definitive treatment such as radiation therapy or radical prostatectomy, according to the investigators.

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“AS is a reasonable option for compliant patients diagnosed with GG2 prostate cancer,” Dr Egan’s team concluded. “While a significant percentage of these men will progress on AS, they do so at a median of 71 months, avoiding treatment-related harms of definitive therapy for over 5 years.”

Future studies with larger, more diverse patient samples are needed to evaluate the oncologic outcomes of men adopting AS for GG2 prostate cancer, according to the investigators. In this study, the AS protocol included an annual PSA test, MRI, and combined MRI-targeted and systematic prostate biopsy.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Egan J, Williams C, Khondakar N, et al. Considerations for active surveillance in select Gleason grade group 2 patients: A preliminary study. Poster presented at the virtual 2021 Genitourinary Cancers Symposium; February 11 to 13. Abstract 206.