The biopsy Gleason score 3+4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3+3: looking for larger selection criteria for XXXX candidates.

@entity1 @entity263 @entity5 @entity3981 @entity4623 @entity3457
BACKGROUND: To assess whether the addition of clinical Gleason score (Gs) 3+4 to the @entity263 Research International: Active Surveillance (PRIAS) criteria affects pathologic results in @entity1 who are potentially suitable for @entity3457 ( @entity3457 ) and to identify possible clinical predictors of unfavourable outcome. METHODS: Three hundred and twenty-nine @entity1 who underwent radical prostatectomy with complete clinical and follow-up data and who would have fulfilled the inclusion criteria of the PRIAS protocol at the time of biopsy except for the addition of biopsy Gs=3+4 and with at least 10 cores taken have been evaluated. One experienced genitourinary pathologist selected those with real Gs=3+3 and 3+4 in only one core according to the 2005 International Society of Urological Pathology criteria. The primary end point was the proportion of unfavourable outcome (nonorgan confined disease or Gs   4+3). Logistic regressions explored the association between preoperative characteristics and the primary end point. RESULTS: Two hundred and four @entity1 were evaluated and 46 (22.5%) @entity1 harboured unfavourable disease at final pathology. After a median follow-up of 73.5 months, there was no @entity5 , and 4 (2.0%) @entity1 had biochemical relapse. There were no significant differences in terms of high Gs, locally advanced disease, unfavourable disease and biochemical relapse-free survival among @entity1 with clinical Gs=3+3 vs Gs=3+4. At multivariable analysis, the presence of @entity3981 ( @entity3981 ) and lower number of core taken were independently associated with a higher risk of unfavourable disease. CONCLUSION: The inclusion of Gs=3+4 in @entity1 suitable to @entity3457 does not enhance the risk of unfavourable disease after radical prostatectomy. Additional factors such as number of cores taken and the presence of @entity3981 should be considered in @entity1 suitable for @entity3457 . @entity263 and @entity4623 advance online publication, 9 June 2015; doi:10.1038/pcan.2015.21.
