Comparison of clinical outcomes between upgraded pathologic Gleason score 3 + 4 and non-upgraded 3 + 4 prostate cancer among patients who are candidates for active surveillance.

ABSTRACT

PURPOSE: To clarify differences patients with pathological GS (pGS) 3 + 4 according to biopsy Gleason score (bGS) after radical prostatectomy (RP) among candidates for active surveillance. METHODS: Between January 2006 and June 2014, 619 patients who met Royal Marsden criteria and had a pGS 3 + 4 after RP were identified. Patients were stratified into two groups according to bGS Group A (n = 430) with bGS (3 + 3) and Group B (n = 189) with bGS 7 (3 + 4). Pathological outcomes were compared between the two groups, and the impact of bGS on adverse pathological outcomes was analyzed by logistic regression and biochemical recurrence (BCR)-free survival compared by log-rank test and the Cox proportional hazards model. RESULTS: The patients in Group B had a higher rate of extracapsular extension (ECE), seminal vesicle invasion and positive surgical margins than those in Group A (p < 0.001, p = 0.005, p = 0.046, respectively). In univariate and multivariate, bGS was significantly associated with ECE [odds ratio (OR) 2.615, p < 0.001; OR 1.769, p < 0.001]. In Kaplan-Meier analysis, BCR-free survival rate was higher in Group A than in Group B (log rank, p = 0.037). In multivariable Cox regression, maximum percentage of core involvement were strongly associated with BCR [hazard ratio (HR) 1.773 (1.248-2.519), p = 0.001]. CONCLUSIONS: pGS 3 + 4 was associated with heterogeneous pathologic and biochemical outcomes according to bGS. Patients with pGS 3 + 4 upgraded from bGS 3 + 3 had more favorable pathological outcomes and biochemical survival outcomes than those with bGS 3 + 4.