Prognostic Significance of the Disparity Between Biopsy and Pathologic Gleason Score After Radical Prostatectomy in Clinical Candidates for Active Surveillance According to the Royal Marsden Criteria.

INTRODUCTION: We identify the biochemical outcome according to biopsy Gleason score (bGS) among patients who are clinical candidate for active surveillance. We found that different adverse pathologic outcomes and biochemical outcomes were shown according to biopsy pattern although the patients have the same pathologic Gleason score (pGS) 3+4 after RP.

BACKGROUND: To identify the biochemical recurrence rate (BCR) according to a pGS upgrade after radical prostatectomy among men with prostate cancer who are clinical candidates for active surveillance (AS) according to the Royal Marsden Hospital criteria.

METHODS: Of the 956 patients with prostate cancer who met the Royal Marsden Hospital criteria for AS underwent radical prostatectomy between January 2006 and June 2014, we enrolled the 830 patients whose pGS was ≤ 3+4 in analysis. We stratified the patients into 3 groups according to the disparity between the bGS and pGS, as follows: group A (n = 211): bGS 3+3 to pGS 3+3; group B (n = 430): bGS 3+3 to pGS 3+4; group C (n = 189): bGS 3+4 to pGS 3+4.

RESULTS: The patients in group C had a higher preoperative prostate-specific antigen level, a higher percentage of positive cores, maximum core involvement (P < .001), and higher postoperative levels of extracapsular extension, seminal vesicle invasion, and positive surgical margins compared with the patients in groups A and B (P < .001, P = .002, and P < .001, for patients in groups C, B, and A, respectively). Group C had a significantly lower BCR-free survival rate compared with groups A and B via Kaplan-Meier, and no difference was observed in the BCR between groups A and B (log rank, P = .475).

CONCLUSION: Although the patients with the same pGS 3+4 after RP, different adverse outcomes were observed. Because of the significantly different prognosis based on the presence of Gleason pattern 4, patients with this pattern are not suitable for AS.