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Population-based study of grade progression in patients who harboured Gleason 3 + 3

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Abstract

Purpose

This study aimed to evaluate (1) the time interval between a decision to commence on active surveillance (AS) and grade progression in community practice; (2) factors predicting grade progression in localised prostate cancer (CaP) patients apparently undergoing AS.

Methods

Data from the Prostate Cancer Outcomes Registry—Victoria were used to analyze men with Gleason 3 + 3 CaP or less who had at least one repeat biopsy. Unadjusted and adjusted 5-year Kaplan–Meier survival curves were used to assess the time to grade progression. Both univariate and multivariate analyses for grade progression were performed using Cox proportional hazards.

Results

The cohort included 951 men. Overall, 39% of men had Gleason grade reclassified to a higher risk disease state with median of 2.2 years [IQR 1.2–3.7 years]. Men who harboured cT2 disease were 30% more likely to have upgrading compared to men with cT1 disease (adjusted HR: 1.3, 95% CI 1.0–1.6, p = 0.048). Half of the men with cT2 in our cohort had their Gleason grade reclassified within 1.6 years from diagnosis as compared with 2.7 years for the cT1 group. The presence of percentage of core involvement >25.0% and a PSA velocity of >1.01 ng/mL/year remained significant for a higher progression rate. The adjusted HR: 1.6; 95% CI [1.2–2.3], p = 0.004; adjusted HR: 1.6, 95% CI [1.2–2.4], p = 0.021, for percent of core involvement of 25.1–37.5%, and ≥37.6%, respectively. The adjusted HRs and p value associated with PSA velocity were 1.5; 95% CI [1.1–2.1], p = 0.016 and 1.6; 95% CI [1.2–2.3], p = 0.003 for PSA velocity values of 1.01–2 ng/mL per year and >2 ng/mL per year, respectively. Men who were diagnosed in regional hospital and subsequently had biopsy in metropolitan hospital were twice at risk of having Gleason upgrade compared to those whom both diagnostic and surveillance biopsies were carried out in metropolitan hospitals (adjusted HR: 1.9; 95% CI 1.1–3.3, p = 0.029).

Conclusions

When placing men on AS and considering time to histologic progression, clinicians should pay particular attention to the likely accuracy of the diagnostic specimen, their tumour stage, volume of tumour (percent of core involvement), and rising PSA. Those diagnosed with T2 disease and had >25.0% of core involvement, and a PSA velocity greater than 1 ng/mL per year is at particular risk for more rapid disease progression and, for this reason, should be counselled on the importance of following the recommended surveillance regimen. For half of these men, their disease will have ‘progressed’ according to biopsy results in 2 years.

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Acknowledgements

We would like to thank the participating clinicians and data collectors for their valuable contribution to the PCOR-Vic. We would also like to gratefully acknowledge Movember Foundation for funding support for this project.

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Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Fanny Sampurno, Arul Earnest, Jeremy Millar & Sue Evans

  2. The William Buckland Radiotherapy Centre, Alfred Health, Melbourne, VIC, Australia

    Jeremy Millar

  3. Australian Urology Associates, Melbourne, VIC, Australia

    Mark Frydenberg

  4. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Declan Murphy

  5. Douglas Hanly Moir Pathology, Macquarie Park, NSW, Australia

    Warwick Delprado

  6. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

    Declan Murphy

Authors
  1. Fanny Sampurno
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  5. Declan Murphy
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  7. Sue Evans
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Contributions

FS designed the study, conducted data analysis, and wrote the manuscript. AE and SE participated in its design, helped with the preparation of the data set and coordination, and helped to draft the manuscript. JM, MF, DM, and WD provided conceptual advice. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fanny Sampurno.

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Conflict of interest

The authors declare that they have no competing interests.

Research involving human participant

The study was approved by the Human Research Ethics Committee of each participating hospital as well as the Monash University Human Research Ethics Committee (CF09/0931-2009000436) and the Cancer Council Victoria (Project No. 0908).

Informed consent

This study used anonymous clinical data that were obtained from patients who have consented to participate in the Prostate Cancer Outcomes Registry—Victoria.

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Sampurno, F., Earnest, A., Millar, J. et al. Population-based study of grade progression in patients who harboured Gleason 3 + 3. World J Urol 35, 1689–1699 (2017). https://doi.org/10.1007/s00345-017-2047-z

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  • DOI: https://doi.org/10.1007/s00345-017-2047-z

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