Change in Prostate Cancer Grade Over Time in Men Followed Expectantly for Stage T1c Disease

Purpose: We assessed whether the Gleason grade changes in men followed expectantly with nonpalpable prostate cancer diagnosed on needle biopsy (stage T1c). Materials and Methods: We studied 241 men with stage T1c prostate cancer who were treated expectantly with repeat yearly needle biopsy sampling to assess for cancer progression. Following the initial cancer diagnosis all men had at least 1 other biopsy demonstrating cancer. Results: Median patient age was 66 years. The number of biopsies showing cancer over time was 2 in 119 (49.4%), 3 in 74 (30.7%), 4 in 33 (13.7%) and 5 or greater in 15 (6.2%). The average followup for those without progression was 32.3 months. Of 241 cases 45 (18.7%) showed a significant change in grade from Gleason score 6 or less to Gleason score 7 or greater (Gleason score 7 in 41 cases, Gleason score 8 in 4 cases). Of 45 (53.5%) cases 24 that showed progression did so within 24 months of diagnosis. Conclusions: Within the first 3 years after diagnosis of Gleason score 6 prostate cancer, there is a relatively low risk of grade progression. Within the first 3 years, our data suggest that in most cases tumor grade did not evolve but rather that the higher grade component was not initially sampled since most grade changes occurred relatively soon after biopsy. Grade progression does appear to occur in some men with long-term followup who had multiple biopsies showing Gleason score 6 followed by higher grade cancer.