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Title: | Feasibility for active surveillance in biopsy Gleason 3 + 4 prostate cancer: an Australian radical prostatectomy cohort. |
Epworth Authors: | Wong, Lih-Ming Tang, Vincent Peters, Justin Costello, Anthony Corcoran, Niall |
Keywords: | Ative Surveillance AS Gleason Score Outcomes Prostate Cancer Prostatic Neoplasms Radical Prostatectomy RP Biochemical Recurrence Adverse Pathology Pathology, Surgical The Australian Prostate Cancer Centre at Epworth |
Issue Date: | Apr-2016 |
Publisher: | Wiley |
Citation: | BJU Int. 2016 Apr;117 Suppl 4:82-7 |
Abstract: | OBJECTIVE: To examine the feasibility of active surveillance for low volume Gleason sum (GS) 3 + 4 disease compared to GS 3 + 3 disease. PATIENTS AND METHODS: Retrospective review of 929 patients, with biopsy proven GS 3 + 3 and 3 + 4 PCa, undergoing upfront radical prostatectomy (RP) was performed. Suitability for AS was adapted from protocols by Royal Marsden Hospital, University of Toronto, and PRIAS by allowing Gleason 3 + 4 disease. The outcomes assessed were adverse pathology at RP (upgrading ≥GS 4 + 3 and/or upstaging ≥pT3) and biochemical recurrence (BCR) after RP. RESULTS: Adverse pathology at RP was compared between GS 3 + 3 vs 3 + 4 groups. When selecting patients using Royal Marsden (n = 714) or University of Toronto (n = 699) protocols, there was statistically significantly more adverse pathology at RP in GS 3 + 4 group (21% vs 31%, P = 0.0028 and 19% vs 33%, P=<0.001 respectively). Using the more stringent PRIAS protocol (n = 198), there was no statistical significant difference in groups. There was no difference in BCR survival between biopsy GS 3 + 3 and 3 + 4 groups, regardless of which AS protocol assessed. Pre-operative PSA and clinical staging were the predictors for BCR. CONCLUSION: Presence of Gleason 3 + 4 at biopsy, when compared to 3 + 3, increases the risk of adverse pathology being present at radical prostatectomy for less stringent selection criteria. When considering AS, a stricter protocol such as PRIAS, limiting PSA density and number of positive cores to ≤2, appears to decrease the risk of adverse pathology. No differences in BCR were seen between biopsy 3 + 3 and 3 + 4 disease, regardless of AS selection criteria. |
URI: | http://hdl.handle.net/11434/691 |
DOI: | 10.1111/bju.13460 |
PubMed URL: | http://www.ncbi.nlm.nih.gov/pubmed/27094971 |
ISSN: | 1464-410X |
Journal Title: | BJU International |
Type: | Journal Article |
Type of Clinical Study or Trial: | Retrospective studies |
Appears in Collections: | Cancer Services Epworth Prostate Centre UroRenal, Vascular |
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