Introduction: We aimed to compare outcomes among men with GG2/3 prostate cancer on initial biopsy with outcomes among men whose disease was initially GG1 but was upgraded to GG2/3 on confirmatory biopsy. Methods: We reviewed patients undergoing radical prostatectomy (RP) in 2 cohorts: “immediate RP group,” with GG2/3 cancer on diagnostic biopsy, and “AS group,” with GG1 cancer on initial biopsy that was upgraded to GG2/3 on confirmatory biopsy. Probabilities of biochemical recurrence (BCR) and salvage therapy using multivariable Cox regression models with risk adjustment. Risk of adverse pathology at RP were also compared using logistic regression. Results: The immediate RP group comprised 4009 patients; the AS group comprised 321. The AS group had lower adjusted rates of adverse pathology (27% vs 35%, p=0.003). BCR rates were lower in the AS group, though this did not reach conventional significance (HR 0.73; 95%CI 0.50-1.06; p=0.10) compared with the immediate RP group. Risk-adjusted 1- and 5-year BCR rates were 4.6% (95%CI 3.0-6.5%) and 10.4% (95%CI 6.9-14%), respectively, for the AS group compared with 6.3% (95%CI 5.6-7.0%) and 20% (95%CI 19-22%) in the immediate RP group. A non-significant association was observed for salvage treatment–free survival favoring the AS group (HR 0.67, 95%CI 0.42, 1.06, p=0.087). Conclusions: We found that men with low-risk cancer who were upgraded on confirmatory biopsy tend to have less aggressive disease than men with the same grade found at initial biopsy. These results must be confirmed in larger series before recommendations can be made regarding a more conservative approach in men with upgraded pathology on surveillance biopsy SOURCE OF Funding:
Funding: This work was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers at MSK, NIH/NCI grant P50 CA092629, and the NIH/NCI Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center (P30 CA008748). Marlon Perera is sponsored by the Australian-America Fulbright Commission administered through a 2021–2022 Fulbright Future Scholarship funded by The Kinghorn Foundation. Sigrid Carlsson is supported by NIH/NCI grant K22 CA234400.
