In a patient with otherwise low-risk prostate cancer, does presence of a small component of Grade Group 3 disease up-stage to unfavorable intermediate?

I agree with Dr. @Dr. First Last's response and will just add a couple of additional thoughts. There are many things that go into making a decision about whether treatment is necessary, and what type of treatment is performed. In this case, it's important to consider patient factors (i.e. age, co-morbid conditions, life expectancy, sexual & urinary function, and personal preferences about treatment), and tumor factors (i.e. PSA, PSA density, amount of Gleason pattern 4 present, whether the cancer is visible on MRI, genomic test results). If the decision is made for treatment, the standard approaches are either surgery (typically robotic prostatectomy) or radiation (+/- ADT). Some patients instead choose focal therapy but this is considered ...

While there is some evidence that the total length of Gleason pattern 4 may improve the prediction of adverse pathology over the percentage of pattern 4, I continue to employ the NCCN risk stratification and accompanying treatment algorithm, which classifies such patients as unfavorable intermediate risk. The most recent version of the NCCN guideline continues to encourage short-term ADT for men with UIR prostate cancer, however, it would be reasonable to omit ADT based on the preliminary result of RTOG 0815, making the management recommendations for such a patient the same as a patient with favorable intermediate risk disease. If this core comes from a targeted biopsy (with the remainder of the GG1 cores from the systematic biopsy), these ...

To answer the question at face value - Yes, I would treat as per UFIR, meaning no active surveillance.

In regard to the other answers, I partially disagree with Dr. @Dr. First Last and mostly agree with Dr. @Dr. First Last. I am unconvinced that 0815 gives any of us a reason to routinely omit ADT in any patient who meets UFIR criteria given improvement in DMFS.

I would await a full paper showing safety of post-hoc analysis of UFIR, especially given median f/u of 6.2 years (very short to determine OS benefit of anything in prostate cancer).

I would err on recommending 4 months given 'barely' UFIR. That being said, it's shared decision making with the patient about the pros/cons of ADT balanced against their other co-morbidities (cardiac, neu...