EXTRA!! EXTRA!! READ ALL ABOUT IT!! ASPI panel on biomarkers expanded to include Myriad’s new Prolaris
+ AS plus MPS2-AS and IsoPSA.
By Howard Wolinsky, Editor, The Active Surveillor
Dr. Angelo A. Baccala Jr., MD, FACS, MBA, will join an ASPI expert panel on June 27 to discuss biomarkers in prostate cancer, with his adding a particular focus on Myriad Genetics’ new Prolaris + AI platform and how it may inform decisions about Active Surveillance versus definitive treatment.
The discussion is entitled Prostate Cancer Testing: What Emerging Biomarkers Mean For You.
Baccala’s fellow panelists are Dr. Jeffery Tosoian, a urology researcher from Vanderbilt, who made news recently in connection with the first biomarker validated for men on Active Surveillance, MyProstateScore2-AS. Also, Dr. Eric Klein, urology chair emeritus at Cleveland Clinic, speaks about another promising biomarker, IsoPSA. See more here.
The meeting is set for Saturday, June 27, from noon to 1:30 p.m.
Go to this link https://aspatients.org/event/a-new-era-in-prostate-cancer-testing/, scroll down and click the register button to get a front-row seat.
Patients are welcome to submit questions in advance to
contactus@aspatients.org. In addition, there will be dedicated time for live Q&A following the presentation. If you can’t make it, register anyway and you’ll get a notice when the video is posted.
Baccala is a graduate of medical school at the Johns Hopkins School of Medicine. He had a urology residency at the Cleveland Clinic, and a urologic oncology fellowship at the National Cancer Institute/NIH.
He now serves as Chief of the Division of Urology at Lehigh Valley Health Network (part of Jefferson Health) and as Deputy Physician-in-Chief of the Lehigh Valley Institute for Surgical Excellence. He also chairs the American Urological Association’s Leadership and Business Education Committee, with a view of how incentives, workflow, and practice patterns shape what patients are offered.
In his ASPI talk, attendees can expect a grounded discussion of where biomarkers like Prolaris + AI truly add value for men on Active Surveillance or considering it, how he uses them in his own decision‑making, and what questions patients should ask when genomic tests are proposed as part of their care.
Check Out ‘This Guy’s Guide: The No-BS Health Report for Men 50+’
By Howard Wolinsky
I appreciate your subscription to The Active Surveillor. But there’s more to men’s health than the finicky prostate and its myriad issues.
In time for June’s Men’s Health Month and Father’s Day, I’m launching “This Guy’s Guide: The No-BS Health Report for Men 50+.”
In This Guy’s Guide, I will cover the full gamut of topics that concern us men over 50: wellness, exercise, diet, sleep, hypertension, BPH, heart disease, cancer, etc. Let me know what you think I should cover: howard.wolinsky@gmail.com
I aim to bring you the facts, often with a lighter touch, once a month.
Get a preview here: https://thisguysguide.substack.com/publish/post/196160545
I hope you will sign up for a free subscription, try it, and upgrade to a paid subscription if you’d like to support my work.
No pressure. No BS, either.
‘Unfavorable Histology’ - A Closer Look at What’s Really in Your Prostate Biopsy
In recent years, pathologists have recognized that certain microscopic patterns, grouped together under the term “unfavorable histology,” carry important warnings about how prostate cancer is likely to behave. Understanding these patterns can help explain why your doctor may recommend treatment even when your overall grade group seems reassuringly low.
What Is Unfavorable Histology?
Unfavorable histology includes five specific microscopic features that, individually or together, signal a more dangerous cancer:
1. All Gleason pattern 5 subtypes: Any cancer showing single cells, cords of cells, or solid sheets with no gland formation represents the most poorly differentiated prostate cancer.
2. Large cribriform cancer: Not all cribriform cancer carries equal risk. Large cribriform glands are most strongly associated with metastasis and prostate cancer death. Small cribriform structures carry a more modest risk; large ones are a red flag even within Grade Group 2.
3. Intraductal carcinoma of the prostate (IDC-P): It is strongly associated with high-grade, high-volume disease and poor outcomes. It can appear alongside lower-grade cancer, making it easy to underestimate the true severity without careful pathological review.
4. Complex intraluminal papillary structures: Cells growing inside gland spaces as papillary structures. Many of these cancers are also considered ductal prostate carcinomas.
5. Anastomosing cords: Extensively interconnected, fused, or branching glands forming irregular networks.
6. Stromogenic carcinoma — Cancer that provokes a dense, reactive scar-like tissue response (desmoplasia) in the surrounding stroma.
What Radical Prostatectomy Studies Tell Us
Most evidence regarding the unfavorable histology comes from studying radical prostatectomy specimens. These studies show that patients with unfavorable histology in their radical prostatectomy specimens have significantly higher rates of cancer spread beyond the gland, biochemical recurrence, and distant metastasis independent of grade group and stage.
How Common Is Unfavorable Histology in Biopsies?
The combined prevalence of intraductal and cribriform carcinoma is approximately 27% in biopsies. Among Grade Group 2 patients, cribriform or IDC was identified in 31% of biopsies. The incidence of other unfavorable histology is not well known.
Why This Matters for You
Prostate cancer with any unfavorable histology feature in your biopsy report should be considered unsuitable for Active Surveillance.
A 2025 study confirmed that pathologists can reliably identify these features in needle biopsies, demonstrating high interobserver agreement in classifying biopsies as favorable or unfavorable, an important step toward routine clinical adoption. If these terms appear in your report, ask your urologist and pathologist to explain their significance.
A second opinion from a genitourinary pathology specialist is always a reasonable step.
References
1. Nguyen JK, Harik LR, Klein EA, et al. Proposal for an optimised definition of adverse pathology (unfavourable histology) that predicts metastatic risk in prostatic adenocarcinoma independent of grade group and pathological stage. Histopathology. 2024;85:598–613.
2. Ding CC, Xiao H, Nguyen JK, et al. Classification of prostatic adenocarcinoma as favourable/unfavourable histology has high interobserver agreement in prostate needle core biopsies. Histopathology. 2025. https://doi.org/10.1111/his.15525.
Dr. Zhou is Chair for Oncological Pathology, Director of Urological Pathology Service and Fellowship Program, Department of Pathology, Molecular and Cell-based Medicine, Mount Sinai Hospital and Icahn School of Medicine in New York City.
For us AS patients these bio markers are really a game changer. I understand it will take some time for these to be incorporated into standard protocols. So it’s important for us AS patients to stay abreast of these new alternatives and be prepared to discuss them
intellectually with our doctors. Information is power. JC