An Increase in Gleason 6 XXXX Volume While on Active Surveillance Portends a Greater Risk of Grade Reclassification with Further Followup.

@entity1 @entity263 @entity5 @entity1486
PURPOSE: We evaluated the relative risk of later grade reclassification and outcomes of @entity1 in whom high volume @entity263 develops while on active surveillance. MATERIALS AND METHODS: A prospectively maintained database was used to identify @entity1 on active surveillance between 1998 and 2013. @entity5 volume was assessed based on the number of positive cores and proportion of core involvement. The chi-square and Fisher exact tests were used for analysis as appropriate. The primary end point was the development of grade reclassification, defined as grade only and/or grade and volume at the event biopsy. RESULTS: A total of 555 @entity1 met the study inclusion criteria. Mean followup was 46 months. Overall 70 @entity1 demonstrated an increase in @entity5 volume at or after biopsy 2. Compared to those @entity1 never experiencing volume or grade reclassification, @entity1486 at diagnosis was not significantly different (p=0.95), but median prostate volume was smaller in @entity1 who demonstrated volume reclassification (p <0.001). The incidence of pure volume reclassification was 6.8%, 6.1% and 7.8% at biopsy 2, 3 and 4, respectively. @entity1 with volume reclassification were more likely to experience later grade reclassification than those without at 33.3% vs 9.3%, respectively (p <0.0001). CONCLUSIONS: While @entity263 has a favorable natural history, it appears that @entity1 on active surveillance who experience volume reclassification are at substantially higher risk for grade reclassification. Thus, urologists should pay close attention to @entity5 core involvement, and monitoring should be adjusted accordingly for early volume reclassification in younger @entity1 and those in good health.
