Objectives: Previous studies has shown that Gleason score (GS) 3+3 does not seem to metastasize or cause prostate cancer specific deaths. The aim of this study was to confirm these findings by investigating whether patients, who had undergone radical prostatectomy (RP) at Sahlgrenska University and were diagnosed with GS ≤ 3+3, have had biochemical recurrence (BCR).
Methods: A review of 2208 patients from Sahlgrenska University Hospital’s database on patients treated with RP open surgery between 1988 and 2008 found a total of 613 patients with GS ≤ 3+3= 6 with a retrievable pathology record. Exclusion criteria were patients with pT3, positive margins, seminal vesicle infiltration and hormonal pre-treatment. Patients’ medical records were reviewed for BCR. BCR was defined as a PSA-value of ≥0.2ng/ml and a consecutive value >0.2ng/ml or clinically treated as relapse. The pathology records of cases meeting the BCR-criteria were reviewed for Gleason grade 4. All cases where no grade 4 was found and the original specimen could be retrieved, were reviewed by an experienced uro-pathologist.
Results: The median follow-up time was 9.3 years (range 0.2-21.7). A total of 30 patients met the criteria for BCR. Of these, the pathology records found Gleason grade 4 (less than 5 %) in 12 cases. Of the 18 remaining cases, 8 specimens could be retrieved for review. Of these, 4 were upgraded and the remaining 4 were still evaluated as GS 3+3=6.
Conclusions: Our study concur with previous findings that Gleason score 3+3 rarely relapses. The majority of BCR cases had Gleason grade 4 which with the contemporary ISUP 2014 would be graded as GS 3+4=7. Though our study shows that GS 3+3=6 seldom relapses it can occur, which implicates that RP patients should be monitored although the timeframe and interval could be discussed.