Changes in Gleason score grading on serial follow-up biopsies in prostate cancer patients undergoing active surveillance - Abstract

INTRODUCTION: Active surveillance for prostate cancer has grown systematically in the recent years with more robust mid-term outcomes.

However, changes in Gleason score during serial biopsies are not detailed in many of these reports.

OBJECTIVES: To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center.

MATERIAL AND METHODS: Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤ 10ng/ml+Gleason≤ 6+T1c/T2a+≤ 2 positive cores, and no more than 50% of affected core. The pathology of each of the biopsies was analyzed.

RESULTS: We studied a series of 175 patients undergoing AS. Mean follow-up was 3.96 years (SD 2.4). Follow-up biopsies with Gleason scores≥7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, in 42.03% of cases did not show evident tumor involvement in the first biopsy, 40.74% and 51.85% in the second and third biopsies respectively. Median stay in the AS program was: 90.99 months (95% CI: 53.53-128.46) in patients with first positive biopsy vs. 96.66 months (95% CI: 63.19-130.13) in those without evidence of tumor.

CONCLUSIONS: In our series the pathological data of the first 3 biopsies remain stable in terms of the positive biopsy rate, Gleason score, or indication of active treatment proportions. Those patients who do not show evidence of malignancy in the first follow-up biopsy are less likely to need active treatment than the other patients in the series.

Written by:
Guijarro A, Hernández V, López B, Capitán C, Pérez-Fernández E, de la Peña E, de la Morena JM, Llorente C.   Are you the author?
Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España; Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Madrid, España.  

Reference: Actas Urol Esp. 2014 Oct 7. pii: S0210-4806(14)00337-4.
doi: 10.1016/j.acuro.2014.08.002

PubMed Abstract
PMID: 25305107 Prostate Cancer Section