@article {105034, title = {Untreated Gleason Grade Progression on Serial Biopsies during Prostate Cancer Active Surveillance: Clinical Course and Pathological Outcomes.}, journal = {The Journal of urology}, volume = {194}, year = {2015}, note = {n/a}, month = {2015 Jul}, pages = {85-90}, abstract = {

PURPOSE: We describe the outcomes of patients with low risk localized prostate cancer who were upgraded on a surveillance biopsy while on active surveillance and evaluated whether delayed treatment was associated with adverse outcome.

MATERIALS AND METHODS: We included men in the study with lower risk disease managed initially with active surveillance and upgraded to Gleason score 3+4 or greater. Patient demographics and disease characteristics were compared. Kaplan-Meier curve was used to estimate the treatment-free probability stratified by initial upgrade (3+4 vs 4+3 or greater), Cox regression analysis was used to examine factors associated with treatment and multivariate logistic regression analysis was used to evaluate the factors associated with adverse outcome at surgery.

RESULTS: The final cohort comprised 219 men, with 150 (68\%) upgraded to 3+4 and 69 (32\%) to 4+3 or greater. Median time to upgrade was 23 months (IQR 11-49). A total of 163 men (74\%) sought treatment, the majority (69\%) with radical prostatectomy. The treatment-free survival rate at 5 years was 22\% for 3+4 and 10\% for 4+3 or greater upgrade. Upgrade to 4+3 or greater, higher prostate specific antigen density at diagnosis and shorter time to initial upgrade were associated with treatment. At surgical pathology 34\% of cancers were downgraded while 6\% were upgraded. Cancer volume at initial upgrade was associated with adverse pathological outcome at surgery (OR 3.33, 95\% CI 1.19-9.29, p=0.02).

CONCLUSIONS: After Gleason score upgrade most patients elected treatment with radical prostatectomy. Among men who deferred definitive intervention, few experienced additional upgrading. At radical prostatectomy only 6\% of cases were upgraded further and only tumor volume at initial upgrade was significantly associated with adverse pathological outcome.

}, keywords = {Adult, Aged, Aged, 80 and over, Biopsy, Disease Progression, Humans, Male, Middle Aged, Neoplasm Grading, Prostate, Prostatic Neoplasms, Retrospective Studies, Watchful Waiting}, issn = {1527-3792}, doi = {10.1111/bju.13445}, author = {Hussein, A A and Welty, C J and Ameli, N and Cowan, J E and Leapman, M and Porten, S P and Shinohara, K and Carroll, P R} }