Absence of cribriform or IDC appears to 'downgrade' aggressiveness of GG 2 but doesn't make risks equal to GG 1, says Zhou
Retelling my journey in Cancer Health, ASPI's next webinar on biomarkers, celebrity news
By Howard Wolinsky
Before setting up Dr. Ming Zhou’s column, I want to share a few things:
—The story of my personal journey appears in the spring edition of Cancer Health Magazine. Why not give it a read: https://www.cancerhealth.com/article/deciding-not-treat-cancer Early reviews are good. Please comment on the story and send me some love. I’m hoping to do more articles for the magazine.
—Calling all Chicagoans on or thinking about Active Surveillance for low-risk prostate cancer. I have had a flurry of emails from men in the Chicago area. So let’s compare notes and swap biopsy stories and need our urologists.The ActiveSurveillor.com newsletter is organizing a lunch at 11:30 a.m. Central time on March 20. Contact me at howard.wolinsky@gmail.com the deets. for the deets,
—ASPI session: Sorting out biomarkers: A Guide for patients on Active Surveillance.” PSAs, MRIs and biopsies each tell part of the story on prostate cancer. But increasingly, biomarkers are playing a role in making decisions on Active Surveillance vs. treatment for men with lower-risk prostate cancer. The program features Jonathan Tward, MD, PhD, an international authority on biomarkers.
The webinar will be held at noon to 1:30 p.m. Eastern on Saturday March 29, 2025.To register, go to: https://zoom.us/meeting/register/wsESZAXeR8Shp7FU60FHvg
Please send questions in advance to: contactus@aspatients.org
Now to Dr. Ming Zhou, Director of Urological Pathology at Mount Sinai Hospital in New York. Dr. Zhou was a hit among The Active Surveillor readership in 2024 as he answered our questions and guided us through the mysteries of uropathology.
He’s been busy lately with lecturing around the world. But he is back for us and taking questions at: Ming.Zhou@mountsinai.org.
Question from a reader: Do men with Gleason score 3+4 (grade group 2) prostate cancer without either cribriform changes or intraductal carcinoma have clinical outcomes comparable to men with Gleason score 3+3 (grade group 1) disease?
A growing body of evidence suggests that men with Gleason score 3+4 (Grade Group 2) prostate cancer without cribriform pattern and intraductal carcinoma (IDC) have better clinical outcomes than tumors without those adverse histologic features.
However, a Gleason pattern 4 is still considered a risk for progression compared to Gleason score 3+3 (Grade Group 2). Furthermore, increments in percent of Gleason pattern 4 correlate with increased risk for adverse clinical outcomes.
In other words, having no cribriform or IDC appears to “downgrade” the aggressiveness of Grade Group 2 cancer but does not make it entirely equivalent to Grade Group 1 cancer in terms of metastatic risk or cancer–specific mortality. That is why NCCN classifies Grade Group 1 as very low and low risk, and Grade Group 2 as intermediate risk.
However, Grade Group 1 with minimal quantity of Gleason pattern 4 (<6%) and Grade Group 1 cancers, when diagnosed on needle biopsy, have similar pathological findings in radical prostatectomy and biochemical recurrence rate. That is why some centers are now recommending active surveillance for patients with Grade Group 2 cancer with minor Gleason pattern 4 component (usually <10%).
Reference:
Huang CC, et al. Gleason score 3 + 4=7 prostate cancer with minimal quantity of gleason pattern 4 on needle biopsy is associated with low-risk tumor in radical prostatectomy specimen. Am J Surg Pathol. 2014 Aug;38(8):1096-101. PMID: 24832163
Kir G et al. Outcomes of Gleason score 3 + 4 = 7 prostate cancer with minimal amounts (<6%) vs ≥6% of Gleason pattern 4 tissue in needle biopsy specimens. Ann Diagn Pathol. 2016 Feb:20:48-51. PMID: 26750655
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Prostate Cancer Early Detection Version 2.2023 — September 26, 2023
NBC weatherman shares his PCa forecast
By Howard Wolinsky
In an interview with SurvivorNet, TODAY weatherman and prostate cancer survivor Al Roker, 67, shares his decision to undergo radical surgery, saying "I just want this out," when talking about his cancer.
"My first reaction was, 'I just want this out. I don't want to do radiation,'" Roker ssaid of the prostate cancer that was growing inside his body. "At the end of the day, I thought, 'surgery first,' then I thought, 'no, maybe radiation,' then I went back and (said), 'no, surgery.' That was that. Once I make a decision, I don't really second-guess it."
To his credit, Roker has made education about prostate cancer his mission, especially among Black men, who face higher rates of PCa than the general population.
[I wish high-profile men on Active Surveillance would follow his example.]
Roker was diagnosed with “aggressive” Gleason 7 in 2020.
He strongly advocates that men undergo PSA testing, which was what uncovered his cancer.
Again, ad nauseam, applaud you, Howard, lending exposure to and putting a real face on prostate cancer, specifically those public figures courageous "fronting" their walk with this "tag", aka Al Roker. I encourage more of the same in light of the AUA News reporting on the Consortium of Disparities of Urological Conditions (ConDUC) in its December 2023 edition. Mortality as reported, certainly known to you but not commonly known, is 2.5 times that of White PCa patients. While SCOPE registries and SEER data are wonderful, both pale in my judgement to education in its lowest form, "boots on the ground" such as your efforts with the blog. I encourage you not to take on one more challenge but in conversation instill need for voice of minorities both here and at webinars, whose experience may be unlike current reporting, both costly and/or limited by the very nature of tools of statistical research. In 2016 Ken Griffey, Jr. toured with Bayer addressing this cancer among 4 uncles and father. My experience setting booths in 6 cites same year, only Black seniors were interested. Approached, a main-line eastern Black advocacy group showed no interest to reach out at the grassroots. Things have changed within the Black community in regards to urgency of need to reach ALL black males. Let us judge for ourselves.
Harley,
The numbers overall must be quite high. Today, about 300,000 men are expected to be diagnosed with prostate cancer. About 55% have low-risk to favorable intermediate-risk cancer, 60% chose AS; of course 40% STILL choose to be treated.
Back when I was diagnosed in 2010, about 200,00 men were diagnosed overall with prostate cancer Only 6-10% of us with low-risk "cancer" opted for Active Surveillance. So ~90% opted to be treated and risking side effects.
Back in the 1990s, the availabllity of the biopsy gun, ultrasound, transrectal biopsies, and PSA testing conspired to create a solid income stream for urologists. A famed uro told me urologists mainly were "clap doctors" before then and then were given the golden egg.
In this period, cases of prostate cancer surged--though most were early Gleason 6 previously unknown or ignored--and treatment "cures" climbed resulting in men experiencing incontinence and erectile dysfunction
Also in this period, legendary Dr. Pat Walsh announced his "nerve-sparing" prostatectomy to protect sexual function. Walsh was hero, but many urologists who adopted the approach were less skilled.
As I heard it, Walsh originally suggested a prime group for his surgery were men with low-risk Gleason 6. The thinking was the men could be cured and their sexuality preserved.
But the 1990s into the 2000s have been a time for an epidemic of avoidable incontinence and sexual dysfunction impacting hundreds of thousands of men.
Howard