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Evaluating the Outcomes of Active Surveillance in Grade Group 2 Prostate Cancer: Prospective Results from the Canary PASS Cohort.

  • Waisman Malaret, Adrian J1
  • Chang, Peter1
  • Zhu, Kehao2
  • Zheng, Yingye2
  • Newcomb, Lisa F3
  • Liu, Menghan2
  • McKenney, Jesse K4
  • Brooks, James D5
  • Carroll, Peter6
  • Dash, Atreya7
  • Filson, Christopher P8
  • Gleave, Martin E9
  • Liss, Michael10
  • Martin, Frances M11
  • Morgan, Todd M12
  • Nelson, Peter S13
  • Lin, Daniel W3, 7
  • Wagner, Andrew A1
  • 1 Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. , (Israel)
  • 2 Biostatistics Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
  • 3 Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
  • 4 Department of Pathology, Cleveland Clinic, Cleveland, Ohio.
  • 5 Department of Urology, Stanford University, Stanford, California.
  • 6 Urology Department, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.
  • 7 Department of Urology, University of Washington, Seattle, Washington.
  • 8 Department of Urology, Emory University, Atlanta, Georgia. , (Georgia)
  • 9 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia.
  • 10 Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas.
  • 11 Urology of Virginia, Virginia Beach, Virginia.
  • 12 Department of Urology, University of Michigan, Ann Arbor, Michigan.
  • 13 Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Published Article
The Journal of urology
Publication Date
Apr 01, 2022
DOI: 10.1097/JU.0000000000002354
PMID: 34854745


Active surveillance (AS) for grade group (GG) 2 patients is not yet well defined. We sought to compare clinical outcomes of men with GG1 and GG2 prostate cancer undergoing AS in a large prospective North American cohort. Participants were prospectively enrolled in an AS study with protocol-directed followup at 10 centers in the U.S. and Canada. We evaluated time from diagnosis to biopsy grade reclassification and time to treatment. In men treated after initial surveillance, adverse pathology and recurrence were also analyzed. At diagnosis, 154 (9%) had GG2 and 1,574 (91%) had GG1. Five-year reclassification rates were similar between GG2 and GG1 (30% vs 37%, p=0.11). However, more patients with GG2 were treated at 5 years (58% vs 34%, p <0.001) and GG at diagnosis was associated with time to treatment (HR=1.41; p=0.01). Treatment rates were similar in patients who reclassified during AS, but in patients who did not reclassify, those diagnosed with GG2 underwent definitive treatment more often than GG1 (5-year treatment rates 52% and 12%, p <0.0001). In participants who underwent radical prostatectomy after initial surveillance, the adjusted risk of adverse pathology was similar (HR=1.26; p=0.4). Biochemical recurrence within 3 years of treatment for GG2 and GG1 patients was 6% for both groups. In patients on AS, the rate of definitive treatment is higher after an initial diagnosis of GG2 than GG1. Adverse pathology after radical prostatectomy and short-term biochemical recurrence after definitive treatment were similar between GG2 and GG1.

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