Purpose To examine if there is a subset of men with Gleason 7 (3+4) prostate cancer who may be potential candidates for active surveillance. Materials and Methods We used the SEARCH database to identify 870 men undergoing radical prostatectomy from 2001-13 with >8 biopsy cores and complete clinical information. We compared characteristics of men who fulfilled low-risk disease criteria (clinical stage T1c/T2a; biopsy Gleason ≤6; PSA ≤10 ng/mL) with the exception of biopsy Gleason 7 (3+4) vs. men who met all 3 low-risk criteria. Logistic regression was used to test the association between biopsy Gleason and pathological features. Biochemical recurrence was examined using Cox hazards analysis. To examine whether there was a subset of men with low-volume Gleason 7 with comparable outcomes to low-risk men, we repeated all analyses limiting the percentage positive cores to ≤33% and positive cores to ≤4, ≤3, or ≤2. Results Gleason 7 low-risk men had increased risk of pathological Gleason ≥4+3 (p0.1), except higher pathological Gleason score (p<0.001). Biochemical recurrence was similar in men with Gleason 6 or Gleason 7 (3+4) (HR 1.39; p=0.254). Conclusion Among men with PSA≤10 ng/mL and clinical stage T1c/T2a, those with Gleason 7 (3+4) in ≤3 total positive cores have similar rates of adverse pathology and biochemical recurrence as men with Gleason ≤6.Master of Public Healt
