Gleason 3+4 - active surveillance or surgery

Written by Nick Brook.

Can men with intermediate risk prostate cancer go on active surveillance?

Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer: Considerations for Active Surveillance Journal of Urology, The, 2018-05-01, Volume 199, Issue 5, Pages 1188-1195

Some guidelines (eg. NCCN - National Comprehensive Cancer Network) suggest that men with small amounts of Gleason 4 (these are men with ISUP GG 2) on their biopsy can go onto active surveillance if other factors are suitable. But not much is known about long-term outcomes compared to that in men in the low risk Gleason score 3+3/Grade Group 1 group.

This study looked at the outcomes of both groups, but for men treated with surgery, to see if the cancer outcomes were equivalent. This is a roundabout way of seeing if active surveillance is safe in men in ISUP GG 2.

The findings showed that 94% of low GG1 and 83% of GG2 had prostate cancer that had not spread beyond the prostate. Invasion into the seminal vesicles was present in 2% of GG1 and in 5% of GG2. Cancer in lymph nodes was seen in 0.3% of GG1 abnd 2% of GG2.

The need for further (radiotherapy) treatment in the future was 6% in GG1 versus 12% in GG2. Finally, PSA remained undetectable in 89% of GG1 and 81% of GG2.