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Vol. 39. Issue 3.
Pages 139-143 (April 2015)
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Vol. 39. Issue 3.
Pages 139-143 (April 2015)
Original article
Changes in Gleason score grading on serial follow-up biopsies in prostate cancer patients undergoing active surveillance
Cambios en el grado de Gleason en las biopsias de seguimiento de pacientes con cáncer de próstata en programa de vigilancia activa
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197
A. Guijarroa,
Corresponding author
ana.guijarroc@gmail.com

Corresponding author.
, V. Hernándeza, B. Lópeza, C. Capitána, E. Pérez-Fernándezb, E. de la Peñaa, J.M. de la Morenaa, C. Llorentea
a Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
b Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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Table 1. Characteristics of patients at diagnosis.
Abstract
Introduction

Active surveillance for prostate cancer has grown systematically in the recent years with more robust mid-term outcomes. However, changes in Gleason score during serial biopsies are not detailed in many of these reports.

Objectives

To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center.

Materials and methods

Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤10ng/ml+Gleason6+T1c/T2a+2 positive cores, and no more than 50% of affected core. The pathology of each of the biopsies was analyzed.

Results

We studied a series of 175 patients undergoing AS. Mean follow-up was 3.96 years (SD 2.4). Follow-up biopsies with Gleason scores7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, 42.03% of cases did not show evident tumor involvement in the first biopsy, 40.74% and 51.85% in the second and third biopsies respectively. Median stay in the AS program was: 90.99 months (CI 95%: 53.53–128.46) in patients with first positive biopsy vs. 96.66 months (CI 95%: 63.19–130.13) in those without evidence of tumor.

Conclusions

In our series the pathological data of the first 3 biopsies remain stable in terms of the positive biopsy rate, Gleason score, or indication of active treatment proportions. Those patients who do not show evidence of malignancy in the first follow-up biopsy are less likely to need active treatment than the other patients in the series.

Keywords:
Prostate cancer
Active surveillance
Follow-up biopsies
Resumen
Introducción

Las series publicadas sobre vigilancia activa (VA) son cada vez más numerosas. La variación del Gleason a lo largo de las biopsias de seguimiento no se detalla en muchas de estas publicaciones.

Objetivos

Evaluar los cambios en el grado de Gleason de las biopsias de seguimiento en pacientes con cáncer de próstata de bajo riesgo en programa de VA.

Material y métodos

Análisis de pacientes diagnosticados entre 2004 y 2013. Criterios de inclusión: PSA10ng/ml, Gleason6, T1c/T2a, ≤2 cilindros positivos, afectación máxima del cilindro de un 50%. Se analizaron los datos anatomopatológicos de cada una de las biopsias.

Resultados

Serie de 175 pacientes incluidos en vigilancia activa con media de seguimiento de 3,96 años (DE: 2,4).

Las tasas de Gleason ≥7 en las biopsias de seguimiento fueron: 5,72% en la primera biopsia, 7,39% y 7,41% en las biopsias sucesivas. Por el contrario, no se evidenció afectación tumoral en el 42,03% de los casos en la primera biopsia, 40,74% y 51,85% en segunda y terceras biopsias respectivamente.

La mediana de permanencia en el programa en los pacientes con la primera biopsia positiva fue 90,99 meses (IC 95%: 53,53-128,46) vs 96,66 meses (IC 95%: 63,19-130,13) en aquellos sin evidencia de malignidad.

Conclusiones

En nuestra serie las 3 primeras biopsias se mantienen con unas proporciones estables en cuanto a positividad de la biopsia, grado de Gleason o indicación de tratamiento activo. Los pacientes que en la primera biopsia de seguimiento no tienen evidencia de malignidad tienen menor probabilidad de necesitar tratamiento activo que el resto de la serie.

Palabras clave:
Cáncer de próstata
Vigilancia activa
Biopsias de seguimiento

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