Population-based study of grade progression in patients who harboured Gleason 3 + 3: Beyond the Abstract

The paper by Sampurno et al provides a profile of subsequent biopsy outcomes for men who commence active surveillance with a Gleason 3+3.1 It delivers two important and contrasting findings. Firstly it identified that in one third of patients diagnosed with 3+3 disease upgrading will occur at a median time of 26 months after diagnosis.

It provides a sobering reminder that vigilance is required in this early period to monitor for progression, particularly in men who present with cT2 disease, are diagnosed in regional hospitals, have >25% positive cores at diagnosis and demonstrate progressively increasing PSA velocity.  It signals the need to review pathology services to identify why specimens processed in pathology services supporting regional hospitals are nearly twice as likely to be upgraded if the repeat biopsy was reviewed by a pathologist servicing metropolitan hospitals.   

The second important message is a positive one.  It provides men with some assurance that repeat biopsies often result in a reduction in cancer grade, even without treatment.  One quarter of men with 3+3 disease will have no cancer detected when they have their first repeat biopsy. For the 206 men who had a second repeat biopsy recorded, 36 (17%) were negative at both first and second biopsy, while for 21 (10%) the second biopsy found no cancer even though the first repeat biopsy was positive (additional data not reported in manuscript).   

Men will likely benefit from understanding their risk of upgrading, based on real world data such as that presented by Sampurno et al.  Such information will empower them to make an informed decision about their own management path. 

Written By: Sue Evans, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

1. Sampurno F, Earnest A, Millar J, et al. Population-based study of grade progression in patients who harboured Gleason 3 + 3. World J Urol 2017.

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