Background: To investigate the feasibility of active surveillance (AS) in biopsy Gleason score (GS) 3 + 4 prostate cancer (PCa), we compared the outcomes of biopsy GS 3 + 3 and 3 + 4 PCa after radical prostatectomy (RP).
Materials and Methods: We analyzed the data of 1,491 patients undergoing RP for biopsy GS 3 + 3 or 3 + 4 PCa who met low-risk criteria of National Comprehensive Cancer Network guidelines regardless of GS. The favorable GS 3 + 4 subgroup was defined when having core involvement ≤ 50%, PSA density ≤ 0.2 ng/mL/cc, and number of positive cores ≤ 2 (maximal 1 core of Gleason 3 + 4).
Results: The low risk GS 3 + 4 group showed significantly worse pathologic outcomes regarding pathologic GS, pathologic stage, and seminal vesicle invasion rate (all p < 0.001) as well as worse biochemical recurrence (BCR)-free survival (p < 0.001) than low risk GS 3 + 3 group. However, “favorable GS 3 + 4 subgroup” showed no significant differences in the pathological outcomes (all p value > 0.05) and also in the the BCR-free survival (p = 0.817) compared with low risk GS 3+3 group.
Conclusions: Despite the application of low-risk criteria, biopsy GS 3 + 4 PCa patients showed significantly worse outcome than biopsy GS 3 + 3 counterparts. However, favorable Gleason 3 + 4 subgroup showed comparable clinico-pathologic outcomes with low-risk GS 3 + 3 patients, suggesting possible expansion of AS into those GS 3 + 4 patients with favorable profiles.