title: Gleason Upgrading with Time in a Large Prostate Cancer Active Surveillance Cohort.
abstract: OBJECTIVE
  We report the percentage of patients on active surveillance who had disease pathologically upgraded and factors that predict for upgrading on surveillance biopsies.
  
  
  METHODS
  Patients in our active surveillance database with at least 1 repeat prostate biopsy were included. Histological upgrading was defined as any increase in primary or secondary Gleason grade on repeat biopsy. Multivariate analysis was used to determine baseline and dynamic factors associated with Gleason upgrading. This information was used to develop a nomogram to predict for upgrading or treatment in patients electing for active surveillance.
  
  
  RESULTS
  Of 862 patients in our cohort 592 had 2 or more biopsies. Median followup was 6.4 years. Of the patients 20% were intermediate risk, 0.3% were high risk and all others were low risk. During active surveillance 31.3% of cases were upgraded. On multivariate analysis clinical stage T2, higher prostate specific antigen and higher percentage of cores involved with disease at the time of diagnosis predicted for upgrading. A total of 27 cases (15% of those upgraded) were Gleason 8 or higher at upgrading, and 62% of all 114 upgraded cases went on to have active treatment. The nomogram incorporated clinical stage, age, prostate specific antigen, core positivity and Gleason score. The concordance index was 0.61.
  
  
  CONCLUSIONS
  In this large re-biopsy cohort with medium-term followup, most cases have not been pathologically upgraded to date. A model predicting for upgrading or radical treatment was developed which could be useful in counseling patients considering active surveillance for prostate cancer.
authors: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
authors: Suneil
authors: S
authors: Jain
authors: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Health Policy, Measurement and Evaluation, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: andrew.loblaw@sunnybrook.ca.
authors: Andrew
authors: A
authors: Loblaw
authors: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Danny
authors: D
authors: Vesprini
authors: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Liying
authors: L
authors: Zhang
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: Michael W
authors: MW
authors: Kattan
authors: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Alexandre
authors: A
authors: Mamedov
authors: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Vibhuti
authors: V
authors: Jethava
authors: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Perakaa
authors: P
authors: Sethukavalan
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: Changhong
authors: C
authors: Yu
authors: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors: Laurence
authors: L
authors: Klotz
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D049451:Nomograms; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D013997:Time Factors; D057832:Watchful Waiting
keywords: neoplasm grading; nomograms; prostatic neoplasms; watchful waiting