Prostate Biopsy Specimens With Gleason 3+3=6 and XXXX : Radical Prostatectomy Findings and Clinical Outcomes.

@entity1 @entity3821 @entity263 @entity5 @entity189 @entity342 @entity2729
Although @entity3821 of the prostate ( @entity2729 ) is typically present on biopsies in which there is also @entity263 of Gleason pattern 4 or 5 and an associated unfavorable outcome, there are limited studies on @entity2729 in needle core biopsies or transurethral resections (TURP) with only a concomitant low-grade invasive component. There are differing opinions on incorporating @entity2729 into the Gleason score in such cases. The aim of this study was to investigate clinical outcomes and radical prostatectomy (RP) findings in @entity1 with Gleason 3+3=6 and @entity2729 on biopsy or TURP. We identified 73 @entity1 in our consult files (2001 to 2014) who had @entity2729 and Gleason score 6 @entity189 on biopsy or TURP with no invasive higher Gleason grade component. Clinical follow-up information was available in 62 @entity1 . Treatment was RP in 14 @entity1 , radiation therapy in 31 @entity1 , @entity342 deprivation therapy in 1 @entity1 , and cryotherapy in 1 @entity1 . Four @entity1 were found to have metastatic disease at the time of diagnosis and were treated with chemotherapy. Eleven @entity1 underwent active surveillance after diagnosis, of which 6 were eventually treated for progressive disease. The 14 RP specimens were centrally reviewed, and 86% had extensive @entity2729 present. The Gleason grades in these 14 RP cases were 3+3=6 in 21%, 3+4=7 in 36%, 4+3=7 in 29%, and 4+4=8 in 14%. Pathologic stage was pT2 in 36%, pT3a in 36%, and pT3b in 28%. After 3 years, there was a 20% actuarial rate of disease progression in @entity1 who underwent either RP or radiation therapy. In summary, most @entity1 with @entity2729 on biopsy/TURP have aggressive @entity5 , even when the invasive @entity5 on biopsy is Gleason score 6. As a minority of @entity1 may only have Gleason 6 invasive @entity5 at RP and a favorable prognosis, we recommend that @entity2729 on biopsy/TURP be reported separately and not assigned a Gleason score.
