Key result
GG2 with ≥2 high-grade cores linked to ~229% higher PSA recurrence versus GG1 after deferred prostatectomy.
Why the study?
As enrollment in active surveillance expands, it is important to assess the potential risks of deferred radical prostatectomy after initial surveillance in men with low or intermediate risk prostate cancer.
Does the baseline Gleason Grade Group and volume of high grade cores predict PSA recurrence in men undergoing deferred radical prostatectomy after active surveillance?
Cohort (n=448)
Does the baseline Gleason Grade Group and volume of high grade cores predict PSA recurrence in men undergoing deferred radical prostatectomy after active surveillance?
Hazard Ratio: 3.29 (95% CI 1.49–7.26)
p-value: p=<0.01
Men with GG2 and 2 or more high grade cores at diagnosis have a significantly higher risk of recurrence after deferred radical prostatectomy and may benefit from immediate treatment, whereas active surveillance appears safe for those with GG2 and 1 high grade core.
GG2 with ≥2 high-grade cores was associated with higher post-RP recurrence; leaves open refined active surveillance selection criteria.
PURPOSE: As enrollment in active surveillance expands, it is increasingly important to assess the potential risks of deferred treatment. We evaluated the risk of prostate specific antigen recurrence in a large cohort of men who underwent radical prostatectomy after initial active surveillance. MATERIALS AND METHODS: The study included men who underwent radical prostatectomy after a period of active surveillance. At diagnosis the men had GG (Gleason Grade Group) 1 or 2, clinical T2 or less and low or intermediate risk disease. They were stratified by a composite variable of GG and the volume of high grade cores at diagnosis. Pathological characteristics and recurrence after radical prostatectomy were evaluated. RESULTS: Of 1,916 men enrolled in active surveillance between 1994 and 2017, 448 (23.4%) underwent deferred radical prostatectomy. Median time to radical prostatectomy was 27 months (IQR 15.5-46.5). At diagnosis 388 men (86.6%) had GG1 disease, 31 (6.9%) had GG2 disease with 1 high grade core and 29 (6.5%) had GG2 disease with 2 or more high grade cores. GG2 with 2 or more high grade cores at diagnosis was associated with an increased risk of recurrence compared to GG1 disease (HR 3.29, 95% CI 1.49-7.26, p <0.01). GG2 disease with 1 high grade core did not significantly differ from GG1. CONCLUSIONS: Our results support the careful use of active surveillance in men with GG2 and 1 high grade core at diagnosis. Men with 2 or more high grade (GG2 or greater) cores at diagnosis may benefit from immediate treatment.
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Balakrishnan et al. (2019) conducted a cohort in Prostate cancer (n=448). Gleason Grade Group 2 disease with 2 or more high grade cores vs. Gleason Grade Group 1 disease was evaluated on Prostate specific antigen recurrence (HR 3.29, 95% CI 1.49-7.26, p=<0.01). GG2 disease with ≥2 high grade cores at diagnosis increased the risk of PSA recurrence after deferred radical prostatectomy compared to GG1 disease (HR 3.29; 95% CI 1.49-7.26; p<0.01).
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