prostate cancer active surveillance and upgrading of the Gleason’s score on subsequent biopsies…new or was it there all along?

I'm looking through you where did you go? I thought I knew you, what did I know. You don't look different but you have changed. I'm looking through you...where did you go? Rubber Soul

I don’t have to read this article. The Gleason did not change…it was there all along. When you do a biopsy and it’s all Gleason 6 and then you remove the prostate and there are elements of Gleason 7, did it change between the time of the biopsy and the subsequent removal….6 weeks? Well no, the biopsy just did not hit the Gleason 7 area. This is one of the issues with active surveillance in the healthy young, you are making decisions based on a “tiny” sampling of the prostate. Are you listening Clark Howard?

Gleason Grade Often Changes During Active Prostate Surveillance



By Dave Levitan

NEW YORK (Reuters Health) Jun 01 – Changes in Gleason score are common during active surveillance for prostate cancer, a new paper says.

About 25% of such men will have subsequent negative biopsies and about 35% will have an upgrade, said lead author Dr. Sima Porten of the University of California, San Francisco, in an e-mail to Reuters Health.

Until now, not much was known about biopsy changes in men who opt for active surveillance, Dr. Porten and colleagues write in their report, published online May 31 in the Journal of Clinical Oncology.

The new study involved 377 men undergoing active surveillance. Ninety-four percent had an initial Gleason score of 6 or less, and 6% had a score of 7 (either 3 + 4 or 4+3).

The mean time to follow-up after the initial biopsy was 54 months. At the first repeat biopsy, 81 men (21%) had an upgraded Gleason score; 91 (24%) had a negative finding, 198 (53%) had no change, and seven men (2%) were downgraded.

Of the 198 with no change after the second biopsy, only 24 were upgraded after a third. Of the 69 men who showed no change until a fourth biopsy, six men then experienced an upgrade. Nearly all the men who had progression on biopsy — 98% — were upgraded to Gleason 3 + 4 disease.

Of the 91 who had a negative second biopsy, 19 (21%) had a positive finding on a third biopsy. Thirteen  of 43 (30%) had cancer discovered on a fourth biopsy.

Fifty-nine percent of men with upgraded score opted for definitive treatment, though the authors noted they haven’t been following the men long enough to make definitive statements on treatment outcomes. Still, Dr. Porten suggests that early data indicate there may be little difference between immediate and delayed treatment.

“In individual patients, biopsy changes are fairly variable over time, but overall, men who experience an upgrade and go on to subsequent treatment have favorable outcomes and seem to be no different than those who are treated outright,” Dr. Porten said.


J Clin Oncol 2011.

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