title: Management of prostate cancer patients with locally adverse pathologic features after radical prostatectomy: feasibility of active surveillance for cases with Gleason grade 3 + 4 = 7.
abstract: OBJECTIVE
  To evaluate the ability of the new Gleason grade groups (GGGs) to stratify risk in prostate cancer patients with locally adverse pathologic features after radical prostatectomy (RP) thereby allowing more accurate assessment for planning eventual adjuvant therapy.
  
  
  METHODS
  Data on 172 patients with locally adverse pathologic features (including seminal vesicle invasion, extracapsular extension, or positive surgical margins) who had been treated with wait and see policy after RP were retrospectively analyzed for biochemical recurrence (BCR)-free survival. Kaplan-Meier survival analysis and Cox proportional hazard regression models were used to test the association between the GGGs and BCR. Finally, concordance indices of different grading classifications were calculated to evaluate the predictive accuracy for biochemical failure after RP.
  
  
  RESULTS
  The five-year BCR-free survival rates were 71.2, 66.9, 25.7, 17.4, and 8.3 % for GGG 1-5 assessed on surgical specimens (p < 0.001, log-rank test). In the two-way log-rank test, men with prostatectomy GGG 2 had a lower progression risk relative to GGG 3 (p = 0.001), though similar risk as GGG 1 (p = 0.105). In multivariate Cox regression analysis, specimen GGG ≥3 and early postoperative PSA ≥0.1 ng/ml were independent risk factors for biochemical failure (p < 0.001). In addition, GGGs had higher predictive accuracy compared with the alternate classification system (improvement in concordance index by 0.036-0.141).
  
  
  CONCLUSIONS
  For the appropriate patient, depending on age, physical condition, early postoperative PSA, patient desire, etc., could be a candidate for wait and see policy with specimen GGG 2 disease, so to distinguish this from GGG 3 may facilitate discussions at the point of treatment decision making.
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Shangguan
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China.
authors.forename: Baijun
authors.initials: B
authors.lastname: Dong
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China.
authors.forename: Yanqing
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Shao
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Sha
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China.
authors.forename: Yinjie
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China. jiahua.pan@outlook.com.
authors.forename: Jiahua
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dong Fang Road, Shanghai, 200127, China. xuewei@renji.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Xue
mesh_terms: D000368:Aged; D019468:Disease Management; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011159:Population Surveillance; D011379:Prognosis; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
keywords: Biochemical recurrence; Gleason grade; Pathology; Prostate cancer; Radiotherapy