Gleason pattern 4: active surveillance no more.

Abstract

To reduce overtreatment of indolent prostate cancer (PCa), urologists have embraced active surveillance (AS) as a management strategy for low-risk PCa; however, patterns-of-care studies are now showing that AS is also being used for patients with intermediate-risk disease. A contemporary Australian study of 980 men reported that 8.9% of men with intermediate-risk disease were placed on AS, of whom 53.8% had Gleason score (GS) 3+4 PCa and 10.4% had GS 4+3 PCa [1]. The most recent update from the CaPSURE database also reflected this trend in AS, but questions remain about the safety of this practice, particularly as the majority of AS protocols worldwide exclude men with GS 4 PCa, unless their life expectancy is limited.