Upgrades in confirmatory biopsies to GG2 may not mean an automatic march to OR, new study suggests
More research needed to confirm
By Howard Wolinsky
Grade Group (GG) 1 (Gleason 6) patients on active surveillance (AS) found to have more advanced disease in a confirmatory biopsy who then undergo radical prostatectomies (RPs) fared better than those patients with GG 2/3 who underwent immediate RPs, researchers from Memorial Sloan Kettering Cancer Center reported in an intriguing new study.
If confirmed in further research, this potentially could mean patients initially diagnosed with GG1 whose cancers were upgraded in a confirmatory biopsy potentially could remain on AS longer, reported Dr. Marlon Perera and colleagues in the current issue of European Urology Focus.
“We found that men with GG1 cancer who were upgraded on confirmatory biopsy tend to have less aggressive disease than men with the same grade found at initial biopsy. These results must be confirmed in larger series before recommendations can be made regarding a more conservative approach in men with upgraded pathology on surveillance biopsy,” the researchers said.
Researchers compared two groups: 4,009 patients in the immediate RP group with initial diagnostic biopsy results of GG2 (Gleason 3+4) and GG 2 (4+3) to 321 patients with diagnostic results of GG of GG1 that reached GG2/3 in confirmatory biopsies. The study covered patients at MSK from 2000 through 2016.
Researchers found the AS group had a lower rate of adverse pathology than the immediate RP group.
Confirmatory biopsies are done six to 18 months after initial biopsies to try to detect cancers that were missed in diagnostic biopsies.
This just in
Dr. Scott Eggener, a UChicago urologist, who has spearheaded a debate on whether Gleason 6, or Grade Group 1, cancer should be renamed as a noncancer, takes on his leading opponent Dr. Jonathan Epstein, a uropathologist at Johns Hopkins, in a newly released podcast and YouTube.
The Active Surveillor is working on a story.
Doctors who favor reclassification argue that Gleason 6 is never lethal and the diagnosis exposes patients to emotional distress and financial toxicity.
Opponents fear that patients will drop surveillance if Gleason 6 were called a noncancer and diagnoses of more advanced cancers will be missed.
To review the issues:
On Apple:
On YouTube:
https://youtube.com/@chadinabhanandhealthcareun4665
To watch the
Initial biopsies typically are performed in the “community” rather than academic medical centers.
MSK researchers explode a widely held belief that diagnostic biopsies performed in the community tend to be upgraded when performed in academic centers.
“Our data suggest that clinicians should not completely disregard initial biopsies in favor of confirmatory biopsies with extensive sampling at high-volume academic centers,” MSK researchers said.
“Moreover, the findings cast doubt on the common practice of using GG2 on confirmatory biopsy as the sole trigger for progression to definitive treatment. Further research is required to support our findings before changes are made to clinical practice. Still, we propose more careful consideration of GG2 on confirmatory biopsy and potentially the use of other clinical, pathological, or genetic parameters to guide such decision-making.”
Since AS became a strategy for closely following low-grade GG1 lesions in the late 1990s, a few patients with GG2 have opted to go on AS.
GG2 patient participation in AS has been low. In recent years it has increased to 20% of these patients from 10%.
Music (Michigan Urological Surgery Improvement Collaborative), which started in 2011 as a statewide initiative to improve urology care, recently reported that more 40% of eligible patients with GG2 go on AS.
Check out the Prostate Cancer Foundation series on diet
By Howard Wolinsky
Dr. Stacey Kenfield, Associate Professor in the Departments of Urology and Epidemiology & Biostatistics at UCSF, was a recent guest on Prostate Cancer Foundation’s monthly webinar series hosted by PCF CEO Dr. Charles Ryan.
I highly recommend her presentation for advice on diet—always a hot topic. Click here.
She said that everything she recommends applies to patients on AS as well as those who have been treated.
Kenfield discusses her research on Prostate 8, a collection of lifestyle changes that have been shown to reduce a patient’s risk of prostate cancer recurrence or death from prostate cancer.
Now, she is answering patient questions in the PCF blog.
Here she answers some of the most common questions posed during the webinar—covering eggs, dairy, sugar, and supplements.
In a follow-up post, she covers recommendations for active surveillance, the role of alcohol drinking, resistance training, and healthy fats.
Basically, the same recommendations that apply to men who have been treated apply to those on AS.
In a nutshell, she advises:
Basically, go easy on dairy and fatty foods and rely more on a plant-based diet to promote heart health. Meat, dairy, eggs, fish, and other seafood will make up a smaller proportion of total food
A plant-based diet is associated with better heart health (lower risk of type 2 diabetes and cardiovascular disease), healthier body weight, and lower risk of death (overall death and death from cardiovascular disease).
If your heart is healthy, your prostate will follow.
Drink alcohol moderately. Some research shows that modest alcohol intake after a diagnosis of prostate cancer (1 drink 3-5 days per week) – may be beneficial.
If you are a non-drinker, it is not recommended to start drinking alcohol to prevent prostate cancer.
Two don't-miss free webinars featuring AS visionaries: Drs. Klotz and Scholz
ASPI presents the latest episode in the cliff-hanging AS 101 video series, featuring Dr. Laurence Klotz, “father of AS.” Active Surveillance Patients International (ASPI) will premier the AS 101 Episode 3 video on Saturday, Jan. 28, 2023, at 12 p.m. Eastern/5 p.m. London. To register, click https://bit.ly/3k7xuPT
AnCan features Dr. Mark Scholz, author of the groundbreaking “Invasion of the Prostate Snatchers” at 8 p.m. Eastern/1 a.m. London Jan. 30.
Scholz’s program is entitled, "Invasion of the Prostate Snatchers: The return 13 years later. An evening with Dr. Mark Scholz." To register, click https://bit.ly/3Xf4nbm
Rising PSA? Want to join a focus group and get a $275 gift card?
IQVIA (www.iqvia.com), a healthcare research firm, is currently conducting a focus group study with patients who have experienced a doubling of their Prostate Specific Antigen (PSA) level within a year of being treated for prostate cancer (sometimes this is also called biochemically recurrent prostate cancer).
The video focus groups will last approximately 2.5 hours. If you are eligible, you will also be asked to complete a form that confirms your diagnosis and a brief online survey about your symptoms. In appreciation of your time, after the focus group, you will receive a $275 electronic gift card.
This research will focus on gaining an understanding of your experience with biochemically recurrent prostate cancer. This research may help improve our overall understanding of the patient and caregiver experience in high-risk biochemically recurrent prostate cancer.
The focus groups will be scheduled to take place in the next several weeks of 2023.
The study is strictly for scientific research purposes; there will be absolutely no sales or promotional activities.
If you are interested, please click on this link to fill out the screener. https://survey.cmix.com/8B856561/7E305C4Q/en-US?RS=1
Email mahnoor.ali@iqvia.com if you have any problems with the form or questions.
IQVIA will also be giving a donation to ZERO for our help with recruitment.