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    Is favorable-risk GG2 prostate Ca suitable for active surveillance?

    FR-GG2 patients more likely to demonstrate worse pathology, higher recurrence rate

    Badar M. Mian, MDBadar M. Mian, MD

    “Journal Article of the Month” is a new Urology Times section in which Badar M. Mian, MD (left), offers perspective on noteworthy research in the peer-reviewed literature.  Dr. Mian is associate professor of surgery in the division of urology at Albany Medical College, Albany, NY.


    Indications for active surveillance for early-stage prostate cancer have expanded recently to include select patients (PSA <10.0 ng/mL, cT2a) with Gleason score 3+4 or Grade Group 2 (GG2) prostate cancer as per National Comprehensive Cancer Network guidelines. In a study published online ahead of print in the Journal of Urology (Dec. 7, 2017), Gearman and colleagues sought to determine the suitability of active surveillance for favorable-risk GG2 (FR-GG2) cancer by analyzing the risk of adverse pathology and oncologic outcomes for surgically treated patients. The authors report that among the potential candidates for active surveillance, those with FR-GG2 were more likely to demonstrate worse pathology and higher rate of cancer recurrence than those with GG1. 

    Also by Dr. Mian: Robotic radical nephrectomy sees steady increase in use

    The authors performed a retrospective review of radical prostatectomy patients and identified 1,735 patients with FR-GG2 prostate cancer (PSA <10.0 ng/mL, T2a) and 6,360 men with GG1. The FR-GG2 group had a higher rate of palpable disease. Following prostatectomy, the FR-GG2 group, in comparison to GG1, had a higher rate of extraprostatic extension (11.6% vs. 4.2%), seminal vesicle invasion (4.6% vs. 1.7%), and lymph node involvement (1.8% vs. 0.3%). On multivariable analysis, patients with FR-GG2 were significantly more likely to have non-organ-confined disease, but increased risk of seminal vesicle invasion and lymph node involvement did not reach statistical significance.

    Men with FR-GG2 had worse estimated 10-year PSA recurrence-free survival (81.2% vs. 88.9%) and systemic progression-free survival (96.5% vs. 99%). Prostate cancer-specific and overall mortality were both slightly higher in the FR-GG2 group (0.9% vs. 0.4% and 10.1 vs. 8.2, respectively). As one might expect from the pathology and PSA recurrence, the FR-GG2 group received additional therapy (radiation and/or hormonal therapy) at a higher rate by about 5%-6%.

    Next: Lengthy study period introduces confounders

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