Is active surveillance an appropriate approach to manage prostate cancer patients with Gleason Score 3+3 who met the criteria for active surveillance?

Özet

Objective: Prostate cancer is one of the common malignant tumors in men worldwide. Nowadays it seemsthat Gleason Score 3+3 may not need definite treatment and some of the experts even ignore it as a cancerbut we should be aware that in some patients with Gleason Score 3+3 there is a higher risk for harboringhigher-grade cancer. We had done this study to evaluate patients with prostate cancer with Gleason Score3+3 to determine the value of tumor volume in these cases.Material and methods: From September 2010 to October 2017, radical prostatectomy was done for 123sequential patients with localized prostate cancer in two referral centers of Shahid Beheshti Medical University, Tehran, Iran, and 42 cases with Gleason Scores 3+3 which who were candidates for active surveillancewere included in the study.Results: Thirty of 42 (71.4%) patients had significant tumor volumes (≥0/5 cm3). When tumor volume wasless than 0.5 cm3, none of the patients had extra prostatic tumor extension. In patients with tumor volumegreater than 0.5 cm3, two cases (6.6%) had extra prostatic extension, 4 cases (13.3%) had positive margins,four cases (13.3%) reactive lymph nodes and 16 cases (53.3%) perineural invasion.Conclusion: We suggest that some patients with Gleason Score 3+3 have tumor volume >0.5 cm3 who areconsidered having significant cancer pathology and active surveillance may not be appropriate approach tomanage all cases with Gleason Score 3+3.