You got questions? Pathologist Zhou has answers.

(Note from Dr. Ming Zhou, Pathologist-in-Chief, Tufts Medical Center: At Howard’s suggestion, I started several months ago to write “The Pathology Report” column to demystify the prostate biopsy pathology reports and help patients like you understand how the pathology results may influence prostate cancer management decisions. I have written about the “atypical prostate glands” and “cribriform cancer glands.” (See links at the end.)

The column has received positive reviews. Howard and I also have received many questions, and I’d like to use this column to answer some of the FAQs from time to time.

Question 1:

“I’m 83 and have been on AS for seven years with a Gleason 3+4 diagnosis. As a pathologist, can you explain the difference between between National Comprehensive Cancer Network (NCCN) favorable intermediate-risk with a Gleason grade 3+4 (grade group 2) and unfavorable intermediate risk with a Gleason grade 3+4 (grade group 2). And how are they different from Gleason 3+4 and Gleason 4+3?”

Dr. Zhou answers: I think you are asking about the difference between National Comprehensive Cancer Network (NCCN) favorable intermediate-risk with a Gleason grade 3+4 (grade group 2) and unfavorable intermediate-risk with a Gleason grade 3+4 (grade group 2).

First of all, NCCN risk stratification uses various factors such as prostate-specific antigen (PSA) level, PSA density, clinical stage, Gleason score (grade group), and tumor volume measurement (% of biopsy cores involved by cancer and % of the biopsy core length involved by cancer). So the Gleason score (grade group) is one factor, but a very important one, in determining the risk group.

Both favorable intermediate-risk and unfavorable intermediate-risk can have Gleason score 3+4 (grade group 2); other factors, however, are different.

For example, favorable intermediate-risk group cancer involves less than 50% of the biopsy cores, and the patient has either a clinical stage cT2b-2c, or PSA 10-20 ng/mL, but not both. In contrast, unfavorable intermediate-risk group cancer involves 50% or more of the biopsy cores, or the patient has both a clinical stage cT2b-2c and PSA 10-20 ng/mL.

Reference:

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)Prostate Cancer Version 4.2023 — September 7, 2023

Question 2:

“Had a biopsy diagnosis by one hospital that concluded that prostatic adenocarcinoma pattern 4 involved 10% of tumor. A second opinion concluded Prostatic adenocarcinoma 3+3  involving two cores (60%,70%) with mucinous fibroplasia. No perineural invasion.

“Does this sound like a plausible interpretation?”

Dr. Zhou answers: This is entirely plausible. Mucinous fibroplasia, also called collagenous micronodules, is a morphological form of prostate cancer, and is composed of collagenous tissue deposited within or outside the cancer glands. The shape and contour of the cancer glands may be distorted as a result and erroneous Gleason grade, may be rendered by unsuspecting pathologists. A Gleason 3+3 prostate cancer with mucinous fibroplasia may be mistaken for Gleason 3+4 or even 4+3.

Reference:

Shah, R.B., Zhou, M. (2019). Diagnosis of Limited Cancer in Prostate Biopsy. In: Prostate Biopsy Interpretation. Springer, Cham. https://doi.org/10.1007/978-3-030-3601-7_3

Question 3:

“What are prostate stones? Do they have to be removed?”

Dr. Zhou answers: Prostate stones, also known as prostate calculi, are small mineral deposits in the prostate gland believed to form due to inflammation or infection in the prostate. stones are usually asymptomatic and discovered incidentally during medical examinations or imaging studies, and treatment is not necessary in such cases.

However, some patients may have symptoms such as pain, frequent or difficult urination, or urinary tract infections, and these patients may require medication to treat the underlying infection and inflammation, transurethral stone removal, or even prostatectomy if other treatments are ineffective.

Reference:

Jyun JS. Clinical Significance of Prostatic Calculi: A Review. World J Mens Health. 2018 Jan; 36(1): 15–21.

Dr. Zhou is the Chair and Pathologist-in-Chief of the Tufts Medical Center, and Professor and Chair of the Department of Anatomic and Clinical Pathology, Tufts  University School of Medicine in Boston. He has published over 200 peer-reviewed articles and numerous book chapters and edited five textbooks of urological and prostate pathology. He is currently a member of the United States and Canadian Academy of Pathology Board of Directors, and the immediate past President of the Genitourinary Pathology Society (GUPS), an international organization for urological pathologists.

Please send questions to mailto:pros8canswers@gmail.com

Keep the questions short and sweet. They should be of general interest. Sign with your real name, or just initials, tell me where you live, how long you‘ve been on AS, how it’s going for for you. Share a whimsical signature if you’re so inclined.

Dr. Zhou’s past columns:

Join me today (Wednesday) at Your Prostate Cancer.help virtual meeting for AS patients

By Howard Wolinsky

Jan Manarite runs a wonderful support group on Active Surveillance. She has her own special style and digs in to help men.

I used to attend her meetings all the time.

But because of a family emergency, she missed her latest meeting.

I volunteered to fill in for Jan at 4-5 p.m. Eastern Wednesday, January 17.

Just click into Zoom at: https://us02web.zoom.us/j/85839374146?pwd=S05OUE52Q2JlNSs1Nkw4Y3VBSjEvdz09 

Hope I’ll see you there.

Don’t miss an ASPI program on genetics and prostate cancer

Active Surveillance Patients International is holding a webinar on genomics at 12-1:30 p.m. January 27.

REGISTER FOR ZOOM

Christina Nakamoto, Medical Science Liaison for Urology at Myriad Genetics, will discuss the benefits of medical-grade, genetic tests and how testing can provide personalized information about a patient's prostate cancer in facilitating an informed shared decision-making process between the patient and his medical team on Active Surveillance and/or other treatment options.  Michael Glode, MD, who serves on ASPI's Medical Advisory Committee, will join the discussion and field questions during a Q &A session.  Send your questions in advance to contactus@aspatients.org.

While we’re at it: Join the ZERO support group on AS in March—I need your support

By Howard Wolinsky

For the past three years, I have run a special Active Surveillance support group for ZERO. Last year, our virtual support meeting drew 60 patients to talk about AS. It was by far the biggest session of any at the annual ZERO Summit.

So sign up now and join us at 11 a.m. Eastern March 12, 2024.

Register in advance for this meeting:
https://us02web.zoom.us/meeting/register/tZUsfuqgrjIoG9AWf7voMhzT_UjdqbQQbQPA