Reducing the rate of biopsy Gleason undergrading may not improve biochemical recurrence rates in active surveillance candidates

Abstract

BACKGROUND: The aim of this study was to explore the impact of improved risk stratification on biochemical recurrence (BCR) rates after surgery in prostate cancer (PC) patients also suitable for active surveillance (AS). Patients with Gleason upgrading were compared to those who were correctly graded with biopsy. Also, to analyze whether AS criteria may be expanded, by comparing patients outside the AS criteria without Gleason upgrading, to men eligible for AS. METHODS: Low-risk PC was widely defined as clinically organ-confined and biopsy Gleason Score ≤3+3=6. Within this group, additional AS eligibility criteria were prostate-specific antigen (PSA)≤10 ng/mL, PSA density <0.2 ng/mL/cc, and ..