title: Changes in Gleason score grading on serial follow-up biopsies in prostate cancer patients undergoing active surveillance.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To evaluate changes in Gleason score on follow-up biopsies in low-risk prostate cancer in patients undergoing AS program in our center.
  
  
  METHODS
  Series of patients diagnosed of prostate cancer between 2004 and 2013 have been analyzed. The inclusion criteria were: PSA ≤ 10 ng/ml + Gleason ≤ 6 + 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 scores ≥ 7 were: 5.72% in the first biopsy, 7.39% and 7.41% in subsequent biopsies. By contrast, in 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 (95% CI: 53.53-128.46) in patients with first positive biopsy vs. 96.66 months (95% CI: 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.
authors.affiliation: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España. Electronic address: ana.guijarroc@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Guijarro
authors.affiliation: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: V
authors.initials: V
authors.lastname: Hernández
authors.affiliation: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: López
authors.affiliation: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Capitán
authors.affiliation: Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Pérez-Fernández
authors.affiliation: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: de la Peña
authors.affiliation: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: de la Morena
authors.affiliation: Servicio de Urología, Hospital Universitario Fundación Alcorcón, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Llorente
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D057832:Watchful Waiting
keywords: Active surveillance; Biopsias de seguimiento; Cáncer de próstata; Follow-up biopsies; Prostate cancer; Vigilancia activa