A few studies have included patients with IRPC in an AS program. One of the largest trials is the one performed by Klotz et al.  The main outcomes measured were overall survival, disease-specific survival, rate of treatment, and PSA failure rate. Twenty-one percent of the patients had IRPC, and 132 had Gleason score (GS) 3+4 disease. One hundred forty-nine of the patients (15%) died, and 844 were still alive at that time. There were 15 deaths from PC (1.5%); the 10-year and 15-year actuarial cause-specific survival rates were 98.1% and 94.3%, respectively, even with 21% of the patients having IRPC. Data from a register-based cohort study of 76,473 PC cases in the National prostate Cancer register (NPCR) of Sweden treated with non-curative intent showed that the observed mortality of men with IRPC was only slightly greater after 5 years of follow-up .
Contemporary Gleason grade 4 PC represents a heterogeneous group of various growth patterns comprising of ill-formed, fused, cribriform and glomeruloid glands. The GS 3+4 cases could be candidates for AS if other clinical characteristics are also favorable. A further classification of the GS 3+4 PCs on the basis of growth patterns results in the identification of a GS 3+4 PC with similar outcomes as those with GS 6 cases, leading them to be considered suitable for AS.
Speaker: M.J. Monique Roobol, MD Professor Department of Urology Erasmus University, Rotterdam, The Netherlands
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands
- Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33:272-7
- Rider JR, Sandin F, Andrén O et al. Long-term outcomes among non-curatively treated men according to prostate cancer risk category in a nationwide, population-based study. Eur Urol. 2013 Jan;63(1):88-96.