{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:52:52Z","timestamp":1791183172930,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30CA008748"],"award-info":[{"award-number":["P30CA008748"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P50CA092629"],"award-info":[{"award-number":["P50CA092629"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate whether total Gleason pattern 4 (GP4) length provides better risk stratification than current risk group criteria for determining potential active surveillance (AS) eligibility, using oncological outcomes after radical prostatectomy (RP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>We identified patients with Grade Group (GG) 2\u20134 disease on magnetic resonance imaging (MRI)\u2010targeted and systematic biopsy who underwent RP. We calculated total GP4 length as the summed millimetres of GP4 in systematic cores plus the average across MRI\u2010targeted cores. Concordance analysis was used to evaluate how increasing GG corresponded to greater GP4 burden. We compared prediction of adverse pathology at RP and 5\u2010year biochemical recurrence (BCR) between risk groups and total length of GP4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2499 patients, 1691, 694, and 114 had GG2, GG3, and GG4 disease, of whom 73%, 19%, and 15% had low amounts (&lt;2\u2009mm) of GP4. Patients with &lt;2\u2009mm of GP4, regardless of GG, had similar risks of adverse pathology (5.2% vs 5.0%) and 5\u2010year BCR (20% vs 21%) as those with favourable intermediate\u2010risk disease; if used as an AS threshold, &lt;2\u2009mm of GP4 would classify approximately twice as many patients as AS eligible, translating to ~50\u2009000 men annually in the United States alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Total length of GP4 provides better risk stratification for AS eligibility than current favourable intermediate\u2010risk group criteria. Further defining the optimal method for GP4 quantification and determining the appropriate cut\u2010point is needed before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70478","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:33:17Z","timestamp":1791181997000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gleason pattern 4 length and active surveillance eligibility in Grade Group 2\u20134 prostate cancer"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8267-1948","authenticated-orcid":false,"given":"Sean A.","family":"Fletcher","sequence":"first","affiliation":[{"name":"Department of Surgery (Urology Service) Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Pickersgill","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service) Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nate","family":"Aiken","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6344-9371","authenticated-orcid":false,"given":"Melissa J.","family":"Assel","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7704-1439","authenticated-orcid":false,"given":"Nicole","family":"Liso","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service) Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor E.","family":"Reuter","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behfar","family":"Ehdaie","sequence":"additional","affiliation":[{"name":"Department of Surgery (Urology Service) Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4322-3736","authenticated-orcid":false,"given":"Samson W.","family":"Fine","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Laboratory Medicine Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1525-6503","authenticated-orcid":false,"given":"Andrew J.","family":"Vickers","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology: Prostate cancer. Version 5.2026. Published January 23 2026. Accessed March 2026"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.1439","article-title":"Time trends and variation in the use of active surveillance for management of low\u2010risk prostate cancer in the US","volume":"6","author":"Cooperberg MR","year":"2023","journal-title":"JAMA Netw Open"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1200\/JCO.2014.55.1192","article-title":"Long\u2010term follow\u2010up of a large active surveillance cohort of patients with prostate cancer","volume":"33","author":"Klotz L","year":"2015","journal-title":"J Clin Oncol"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1056\/NEJMoa2214122","article-title":"Fifteen\u2010year outcomes after monitoring, surgery, or radiotherapy for prostate cancer","volume":"388","author":"Hamdy FC","year":"2023","journal-title":"N Engl J Med"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1111\/his.70052","article-title":"Rethinking Gleason pattern quantification in predicting metastasis: results of 20\u2009years of follow\u2010up in the Rotterdam section of the European randomized study of screening for prostate cancer","volume":"88","author":"Kroon LJ","year":"2026","journal-title":"Histopathology"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1111\/bju.12879","article-title":"Disease\u2010specific death and metastasis do not occur in patients with Gleason score \u22646 at radical prostatectomy","volume":"116","author":"Kweldam CF","year":"2015","journal-title":"BJU Int"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/JU.0000000000003825","article-title":"Risk of biochemical recurrence in patients with grade group 1 prostate cancer with extraprostatic extension treated with radical prostatectomy","volume":"211","author":"Rezaee ME","year":"2024","journal-title":"J Urol"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.6004\/jnccn.2023.0050","article-title":"Prostate cancer, version 4.2023, NCCN clinical practice guidelines in oncology","volume":"21","author":"Schaeffer EM","year":"2023","journal-title":"J Natl Compr Cancer Netw"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/j.eururo.2013.03.033","article-title":"A new risk classification system for therapeutic decision making with intermediate\u2010risk prostate cancer patients undergoing dose\u2010escalated external\u2010beam radiation therapy","volume":"64","author":"Zumsteg ZS","year":"2013","journal-title":"Eur Urol"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/JU.0000000000002757","article-title":"Clinically localized prostate cancer: AUA\/ASTRO guideline, part I: introduction, risk assessment, staging, and risk\u2010based management. [Miscellaneous Article]","volume":"208","author":"Eastham JA","year":"2022","journal-title":"J Urol"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU\u2010EANM\u2010ESTRO\u2010ESUR\u2010ISUP\u2010SIOG guidelines on prostate cancer\u20142024 update. Part I: screening, diagnosis, and local treatment with curative intent","volume":"86","author":"Cornford P","year":"2024","journal-title":"Eur Urol"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1097\/JU.0000000000004484","article-title":"The absolute volume of Gleason pattern 4 on radical prostatectomy is more strongly associated with advanced stage and biochemical recurrence than Gleason grade groups","volume":"213","author":"Scuderi S","year":"2025","journal-title":"J Urol"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","unstructured":"PickersgillNA FletcherSA AikenN et\u00a0al.Total Gleason pattern 4 length outperforms grade group and clinical models in predicting oncologic outcomes in grade group 2\u20104 prostate cancer.medRxiv. Preprint posted online March 2 2026: 2026.02.27.26347289.https:\/\/doi.org\/10.64898\/2026.02.27.26347289","DOI":"10.64898\/2026.02.27.26347289"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1111\/bju.16884","article-title":"Quantification of prostate cancer Gleason pattern 4 to predict oncological outcome","volume":"136","author":"Olivier J","year":"2025","journal-title":"BJU Int"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/JU.0000000000002685","article-title":"Oncologic outcomes of total length Gleason pattern 4 on biopsy in men with grade group 2 prostate cancer","volume":"208","author":"Perera M","year":"2022","journal-title":"J Urol"},{"key":"e_1_2_10_17_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2021"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","DOI":"10.21105\/joss.01686","article-title":"Welcome to the tidyverse","volume":"4","author":"Wickham H","year":"2019","journal-title":"J Open Source Softw"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"570","DOI":"10.32614\/RJ-2021-053","article-title":"Reproducible summary tables with the gtsummary package","volume":"13","author":"Sjoberg DD","year":"2021","journal-title":"R J"},{"key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.juro.2018.07.062","article-title":"Clinical usefulness of total length of Gleason pattern 4 on biopsy in men with grade group 2 prostate cancer","volume":"201","author":"Dean LW","year":"2019","journal-title":"J Urol"},{"key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1001\/jama.280.11.969","article-title":"Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer","volume":"280","author":"D'Amico AV","year":"1998","journal-title":"JAMA"},{"key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/JU.0000000000003012","article-title":"The use and short\u2010term outcomes of active surveillance in men with National Comprehensive Cancer Network favorable intermediate\u2010risk prostate cancer: the initial Michigan urological surgery improvement collaborative experience","volume":"209","author":"Paudel R","year":"2023","journal-title":"J Urol"},{"key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/S1470-2045(25)00438-3","article-title":"Revisiting prostate cancer active surveillance candidacy","volume":"26","author":"Spratt DE","year":"2025","journal-title":"Lancet Oncol"},{"key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/JU.0000000000003461","article-title":"Identifying men who can remain on active surveillance despite biopsy reclassification to grade group 2 prostate cancer","volume":"210","author":"Baraban E","year":"2023","journal-title":"J Urol"},{"key":"e_1_2_10_25_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.clgc.2024.102204","article-title":"Quantification of Gleason pattern 4 metrics identifies pathologic progression in patients with grade group 2 prostate cancer on active surveillance","volume":"22","author":"Perera M","year":"2024","journal-title":"Clin Genitourin Cancer"},{"key":"e_1_2_10_26_1","article-title":"Cancer statistics, 2026","volume":"76","author":"Siegel RL","year":"2026","journal-title":"CA Cancer J Clin"},{"key":"e_1_2_10_27_1","volume-title":"U.S. Cancer Statistics Prostate Cancer Stat Bite","author":"CDC","year":"2026"},{"key":"e_1_2_10_28_1","doi-asserted-by":"crossref","DOI":"10.1093\/jncics\/pkad018","article-title":"Prostate cancer grade migration and facility\u2010level treatment trends for grade group 1 disease","volume":"7","author":"Borregales LD","year":"2023","journal-title":"JNCI Cancer Spectr"},{"key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/cam4.3571","article-title":"Differences in survival of prostate cancer Gleason 8\u201310 disease and the establishment of a new Gleason survival grading system","volume":"10","author":"Zhou Y","year":"2020","journal-title":"Cancer Med"},{"key":"e_1_2_10_30_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2025.39250","article-title":"Cost\u2010effectiveness and evidence gaps surrounding PSMA\u2010PET for recurrent prostate cancer evaluation","volume":"8","author":"Kunst N","year":"2025","journal-title":"JAMA Netw Open"},{"key":"e_1_2_10_31_1","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.eururo.2014.07.010","article-title":"Adverse effects of androgen deprivation therapy and strategies to mitigate them","volume":"67","author":"Nguyen PL","year":"2015","journal-title":"Eur Urol"},{"key":"e_1_2_10_32_1","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1097\/PAS.0b013e3182217b79","article-title":"Should intervening benign tissue be included in the measurement of discontinuous foci of cancer on prostate needle biopsy? Correlation with radical prostatectomy findings","volume":"35","author":"Karram S","year":"2011","journal-title":"Am J Surg Pathol"},{"key":"e_1_2_10_33_1","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/j.1365-2559.2008.03087.x","article-title":"Prognostic value of various morphometric measurements of tumour extent in prostate needle core tissue","volume":"53","author":"Brimo F","year":"2008","journal-title":"Histopathology"},{"key":"e_1_2_10_34_1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.eururo.2025.11.013","article-title":"Evaluating tumor quantification in place of proportions in prostate cancer: principles of the ProQuant group","volume":"89","author":"Vickers AJ","year":"2026","journal-title":"Eur Urol"},{"key":"e_1_2_10_35_1","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1111\/his.15231","article-title":"Proposal for an optimised definition of adverse pathology (unfavourable histology) that predicts metastatic risk in prostatic adenocarcinoma independent of grade group and pathological stage","volume":"85","author":"Nguyen JK","year":"2024","journal-title":"Histopathology"},{"key":"e_1_2_10_36_1","doi-asserted-by":"crossref","DOI":"10.1111\/bju.70261","article-title":"Long\u2010term outcomes of cribriform\u2010positive and cribriform\u2010negative prostate cancer treated with radical prostatectomy in the ProtecT trial","volume":"137","author":"Sushentsev N","year":"2026","journal-title":"BJU Int"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70478","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bju.70478","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70478","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:33:23Z","timestamp":1791182003000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.70478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,4]]},"references-count":35,"alternative-id":["10.1111\/bju.70478"],"URL":"https:\/\/doi.org\/10.1111\/bju.70478","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,4]]},"assertion":[{"value":"2026-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"bju.70478"}}