In Reply We greatly value the insights provided by Dr Klotz on our recent study1 of pathologic outcomes among men with low-volume Gleason 3 + 4 (grade group [GG] 2) prostate cancer. We agree that patients with GG2 prostate cancer who have a low percentage of Gleason pattern 4 (≤5%) are an additional important subset to consider because many may be downgraded to GG1 (Gleason 3 + 3).2 Unfortunately, our data are still maturing for this subset, so it is too early to comment on the rate of adverse pathologic findings. One prior institutional report included only 22 patients meeting the 5% Gleason pattern 4 threshold, but the majority were notably downgraded to GG1 (Gleason 3 + 3) after radical prostatectomy. The 22 patients represented approximately 20% of all GG2 (Gleason 3 + 4) patients in the institutional experience, making it a critical group to evaluate in larger studies in the future.
Patel HD, Tosoian JJ, Carter HB, Epstein JI. Stratifying Risk for Men With Low-Volume Intermediate-Risk Prostate Cancer—Reply. JAMA Oncol. 2018;4(8):1133–1134. doi:10.1001/jamaoncol.2018.0754
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