Identifying subgroups of men who can remain on AS despite biopsy reclassification to GG2
Often reclassification to Grade Group 2 from Grade Group 1 prostate cancer results in men leaving active surveillance. To date, there has been limited data available to guide this decision making. This study aimed to identify subgroups of men who can safely remain on active surveillance despite reclassification to Grade Group 2.
Researchers studied 249 active surveillance patients with surveillance biopsies classified as Grade Group 1 or Grade Group 2 who underwent radical prostatectomy. Perineural invasion, cancer volume, linear length, of cancer in the biopsy specimens, maximum percentage of Gleason pattern 4 cancer, and PSA density were evaluated. GG2 patients with low PSA density and without PNI have lower risk for adverse pathology than GG1 patients with these risk factors
Fifty-Seven percent of Grade Group 1 men reclassified to Grade Group 2 while on active surveillance had favorable radical prostatectomy pathology. Those without biopsy perineural invasion and with low PSA density were more likely to have favorable radical prostatectomy pathology.
The researchers conclude that reclassification to Grade Group 2 alone should not disqualify men from remaining on active surveillance in the absence of other worrisome findings.
These findings are limited by the retrospective and single-institution design of the study.
J Urol. 2023 Jul;210(1):99-107. doi: 10.1097/JU.0000000000003461. Epub 2023 Apr 12.
