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Bullen J, Nickel B, McCaffery K, Wilt TJ, Smith J, Boroumand F, Parker L, Millar J, Brodersen JB, Dahm P, Delahunt B, Varma M, Glasziou P, Warden A, Diller L, Billington L, van Rensburg C, Bell K. Impact of the diagnostic label for a low-risk prostate lesion: protocol for two online factorial randomised experiments. BMJ Open 2024; 14:e085947. [PMID: 39122400 DOI: 10.1136/bmjopen-2024-085947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Many types of prostate cancer present minimal risk to a man's lifespan or well-being, but existing terminology makes it difficult for men to distinguish these from high-risk prostate cancers. This study aims to explore whether using an alternative label for low-risk prostate cancer influences management choice and anxiety levels among Australian men and their partners. METHODS AND ANALYSIS We will run two separate studies for Australian men and Australian women with a male partner. Both studies are between-subjects factorial (3×2) randomised online hypothetical experiments. Following consent, eligible participants will be randomised 1:1:1 to three labels: 'low-risk prostate cancer, Gleason Group 1', 'low-risk prostate neoplasm' or 'low-risk prostate lesion'. Participants will then undergo a second randomisation step with 1:1 allocation to the provision of detailed information on the benefits and harms of different management choices versus the provision of less detailed information about management choices. The required sample sizes are 1290 men and 1410 women. The primary outcome is the participant choice of their preferred management strategy: no immediate treatment (prostate-specific antigen (PSA)-based monitoring or active surveillance using PSA, MRI, biopsy with delayed treatment for disease progression) versus immediate treatment (prostatectomy or radiation therapy). Secondary outcomes include preferred management choice (from the four options listed above), diagnosis anxiety, management choice anxiety and management choice at a later time point (for participants who initially choose a monitoring strategy). ETHICS AND DISSEMINATION Ethics approval has been received from The University of Sydney Human Research Ethics Committee (2023/572). The results of the study will be published in a peer-reviewed medical journal and a plain language summary of the findings will be shared on the Wiser Healthcare publications page http://www.wiserhealthcare.org.au/category/publications/ TRIAL REGISTRATION NUMBERS: Australian New Zealand Clinical Trials Registry (ID 386701 and 386889).
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Affiliation(s)
- James Bullen
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
| | - Timothy J Wilt
- Center for Chronic Disease Outcomes Research and Minneapolis VA High Value Care Initiative, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, Section of General Internal Medicine, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Farzaneh Boroumand
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Parker
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Royal North Shore Hospital, NSW Health, Sydney, New South Wales, Australia
| | - Jeremy Millar
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John Brandt Brodersen
- Centre of General Practice, Department of Public Health & Research Unit for General Practice, Region Zealand, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Department of Community Medicine, UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
- Urology Section, Minneapolis Veterans Administration Health System, Minneapolis, Minnesota, USA
| | - Brett Delahunt
- Wellington School of Medicine and Health Sciences, University of Otago Wellington, Wellington, New Zealand
| | - Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Andrew Warden
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
| | - Lawrence Diller
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
| | - Larry Billington
- Health Consumers New South Wales, Sydney, New South Wales, Australia
| | | | - Katy Bell
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
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Samaratunga H, Egevad L, Yaxley J, Perry-Keene J, Le Fevre I, Kench J, Matsika A, Bostwick D, Iczkowski K, Delahunt B. Gleason score 3+3=6 prostatic adenocarcinoma is not benign and the current debate is unhelpful to clinicians and patients. Pathology 2024; 56:33-38. [PMID: 38071161 DOI: 10.1016/j.pathol.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 01/24/2024]
Abstract
Prostate adenocarcinoma is a common malignancy associated with a significant morbidity and mortality. In both prostate biopsies and radical prostatectomy specimens Gleason scoring informs both treatment and outcome prediction. The current convention is that in needle biopsies, Gleason patterns 3, 4 and 5 are considered to be malignant. Despite this there is debate as to whether or not Gleason score (GS) 3+3=6 should be diagnosed as cancer due to potential over-treatment and the psychological impact on patients. It is apparent that GS 3+3=6 is indolent disease with a low risk of metastasis. However, it does have the histological features of malignancy and is capable of infiltrating the prostate gland, extraprostatic extension, and metastatic spread. Furthermore GS 3+3=6 carcinoma has immunohistochemical and molecular genetic features similar to those of higher grade prostatic carcinoma. If GS 3+3=6 tumour is considered benign, the question arises should a benign label be given to the Gleason pattern 3 component of tumour that includes Gleason patterns of higher grade? This would seem a logical step as GS 3+3=6 cancers and the pattern 3 component in cancers with multiple patterns are morphologically identical. If pattern 3 is considered to be benign, then Gleason scoring would be limited to 4+4=8, 4+5=9, 5+4=9 and 5+5=10 which is clearly inappropriate. The correct strategy to address potential over-treatment of patients with low-grade cancer is clinician and patient education, not the recalibration of Gleason grading to reclassify malignant tumours as benign.
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Affiliation(s)
- Hemamali Samaratunga
- Aquesta Uropathology, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Instituet, Stockholm, Sweden
| | - John Yaxley
- University of Queensland, Brisbane, Qld, Australia; Wesley Hospital, Brisbane, Qld, Australia
| | - Joanna Perry-Keene
- Aquesta Uropathology, Brisbane, Qld, Australia; Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | | | - James Kench
- Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Admire Matsika
- University of Queensland, Brisbane, Qld, Australia; Mater Health, Brisbane, Qld, Australia
| | | | - Kenneth Iczkowski
- Department of Pathology, University of California Davis, Sacramento, CA, USA
| | - Brett Delahunt
- Department of Oncology and Pathology, Karolinska Instituet, Stockholm, Sweden; Malaghan Institute of Medical Research, Wellington, New Zealand.
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