title: Change in prostate cancer grade over time in men followed expectantly for stage T1c disease.
abstract: OBJECTIVE
  We assessed whether the Gleason grade changes in men followed expectantly with nonpalpable prostate cancer diagnosed on needle biopsy (stage T1c).
  
  
  METHODS
  We studied 241 men with stage T1c prostate cancer who were treated expectantly with repeat yearly needle biopsy sampling to assess for cancer progression. Following the initial cancer diagnosis all men had at least 1 other biopsy demonstrating cancer.
  
  
  RESULTS
  Median patient age was 66 years. The number of biopsies showing cancer over time was 2 in 119 (49.4%), 3 in 74 (30.7%), 4 in 33 (13.7%) and 5 or greater in 15 (6.2%). The average followup for those without progression was 32.3 months. Of 241 cases 45 (18.7%) showed a significant change in grade from Gleason score 6 or less to Gleason score 7 or greater (Gleason score 7 in 41 cases, Gleason score 8 in 4 cases). Of 45 (53.5%) cases 24 that showed progression did so within 24 months of diagnosis.
  
  
  CONCLUSIONS
  Within the first 3 years after diagnosis of Gleason score 6 prostate cancer, there is a relatively low risk of grade progression. Within the first 3 years, our data suggest that in most cases tumor grade did not evolve but rather that the higher grade component was not initially sampled since most grade changes occurred relatively soon after biopsy. Grade progression does appear to occur in some men with long-term followup who had multiple biopsies showing Gleason score 6 followed by higher grade cancer.
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21231, USA.
authors.forename: Todd B
authors.initials: TB
authors.lastname: Sheridan
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
authors.forename: Wenle
authors.initials: W
authors.lastname: Wang
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Landis
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy; D013997:Time Factors