Abstract
Background
To report active surveillance (AS) outcomes in patients with Grade Group (GG) 2 prostate cancer (PCa) according to the baseline amount of pattern 4 on image-guided biopsy.
Methods
Our database includes GG2 PCa patients managed with AS in ten European centers.
Results
In total, 104 patients were included (median pattern 4: 10%, ranges 5–40). The percentage of pattern 4 was not statistically correlated with upgrading (Spearman, r = 0.073, p = 0.5) or downgrading on confirmatory biopsy (r = −0.049, p = 0.6). The median follow-up was 33 months. In multivariable Cox regression analysis, percentage of pattern 4 was not associated with GG3 upgrading (p = 0.6) or definitive treatment (p = 0.4).
Conclusions
Patients with GG2 PCa should not be excluded from AS solely because of grade 4 > 10% when other parameters are otherwise favorable.
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Conceived and designed the analysis: MB, AU, GP; performed the analysis: MB, AU, GP; wrote the manuscript: MB, AU, GP; Collected data: AU, MB, RL, MO, AP, CK, MA, CD, HB, JO, ARR, FS, VB, OW, MV, GG, GP; provided critical feedback in shaping the manuscript: RL, MO, AP, CK, MA, CD, HB, JO, ARR, FS, VB, OW, MV, GG.
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Uleri, A., Baboudjian, M., Leni, R. et al. Gleason pattern 4 and active surveillance in patients with grade group 2 prostate cancer. Prostate Cancer Prostatic Dis 29, 205–206 (2026). https://doi.org/10.1038/s41391-025-00977-6
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DOI: https://doi.org/10.1038/s41391-025-00977-6
