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. 2025 Apr 29.
doi: 10.1038/s41391-025-00977-6. Online ahead of print.

Gleason pattern 4 and active surveillance in patients with grade group 2 prostate cancer

Alessandro Uleri  1 , Michael Baboudjian  2 , Riccardo Leni  3   4 , Marco Oderda  5 , Arthur Peyrottes  6 , Claudia Kesch  7 , Mulham Al-Nader  7 , Charles Dariane  8 , Helene Baud  8 , Jonathan Olivier  9 , Anna Redondo Rios  10 , Francesco Sanguedolce  10 , Vincent Benard  11 , Olivier Windisch  11 , Massimo Valerio  11 , Giorgio Gandaglia  3   4 , Guillaume Ploussard  12
Affiliations

Gleason pattern 4 and active surveillance in patients with grade group 2 prostate cancer

Alessandro Uleri et al. Prostate Cancer Prostatic Dis. .

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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Conflict of interest statement

Competing interests: The authors declare no competing interests.

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