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# Total Gleason pattern 4 length outperforms risk groups for surveillance eligibility
- URL: https://www.coios.me/total-gleason-pattern-4-length-outperforms-risk-groups-for/
- Published: 2026-10-06T12:55:17.000Z
- Updated: 2026-10-07T06:04:29.000Z
- Description: In 2499 men with Grade Group 2-4 prostate cancer treated by radical prostatectomy, those with under 2 mm of total Gleason pattern 4, whatever their grade group, had adverse pathology in 5.2% and 5-year biochemical recurrence in 20%, matching favourable intermediate-risk disease.
- Author: Daniel Ryan
- Tags: Healthcare today, Cancer, United States, #peer-reviewed, #refines, #item, #source-2026-10

Researchers measured total Gleason pattern 4 length across systematic and MRI-targeted biopsy cores in 2499 men with Grade Group 2-4 prostate cancer who went on to radical prostatectomy, and compared it with current risk-group criteria as a predictor of adverse pathology and 5-year biochemical recurrence. Men with under 2 mm of pattern 4 had 5.2% adverse pathology and 20% 5-year recurrence, indistinguishable from favourable intermediate-risk disease, and 73% of Grade Group 2 cases fell below that threshold. Applied as an eligibility rule it would roughly double the number classed as suitable for active surveillance, though the authors say the quantification method and cut-point still need defining.

*Why it is interesting: A quantitative biopsy measure that would reclassify a large share of Grade Group 2 disease, 73% of which fell below the 2 mm threshold.*

Source

[BJU International, 4 October 2026](https://doi.org/10.1111/bju.70478?ref=coios.me)

DOI

10.1111/bju.70478

Type

Peer-reviewed article

Design

Retrospective cohort of 2499 men with Grade Group 2-4 prostate cancer on MRI-targeted and systematic biopsy followed after radical prostatectomy, with 5-year biochemical recurrence

Verdict

Refines prior evidence

Driver

[Cancer](https://www.coios.me/d-cancer/)

Free full text

[Free to read at the publisher](https://doi.org/10.1111/bju.70478?ref=coios.me)