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

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.