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How much does Gleason grade of follow‐up biopsy differ from that of initial biopsy in untreated, Gleason score 4–7, clinically localized prostate cancer?
Author(s) -
Choo R.,
Danjoux C.,
Morton G.,
Szumacher E.,
Sugar L.,
Gardner S.,
Kim M.,
Choo C.M.,
Klotz L.
Publication year - 2007
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.20648
Subject(s) - medicine , biopsy , prostate cancer , malignancy , prostate , prostate biopsy , urology , cancer , prospective cohort study , cohort , radiology , surgery
OBJECTIVE To compare histologic grades between an initial biopsy and a follow‐up biopsy in untreated, Gleason score (GS) 4–7, clinically localized prostate cancer. METHODS AND MATERIALS In a prospective single‐arm cohort study, clinically localized, GS 4–7, prostate cancer was managed with active surveillance alone, provided that a pre‐defined definition of disease progression was not met. One hundred five (63%) of a total of 168 eligible patients underwent a follow‐up prostate biopsy during surveillance. Median time to a follow‐up biopsy was 22 months (range: 7–81). Histologic grades between these two biopsies were compared to evaluate the extent of histologic grade change. RESULTS On the follow‐up biopsy, GS was unchanged in 33 patients (31%), upgraded in 37 (35%), and downgraded in 34 (32%). Eleven (10%) had upgrading by 2 Gleason points or more. Eight (8%) had upgrading to GS 8 (none to GS 9 or 10); of these, six were among those with upgrading by 2 Gleason points or more. Twenty‐seven (26%) had no malignancy on the follow‐up biopsy. Negative follow‐up biopsy was more prevalent in patients with a small volume of malignancy in the initial biopsy and a low baseline PSA. CONCLUSIONS No consistent change in histologic grade was observed on the follow‐up biopsy at a median of 22 months in untreated, GS 4–7, clinically localized prostate cancer. Upgrading to GS ≥8 or by 2 Gleason points or more was relatively uncommon. Prostate 67: 1614–1620, 2007. © 2007 Wiley‐Liss, Inc.