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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 PMCID: PMC11331948 DOI: 10.1136/bmjopen-2024-085947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/30/2024] [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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Ho KKY, Kaiser UB, Chanson P, Gadelha M, Wass J, Nieman L, Little A, Aghi MK, Raetzman L, Post K, Raverot G, Borowsky AD, Erickson D, Castaño JP, Laws ER, Zatelli MC, Sisco J, Esserman L, Yuen KCJ, Reincke M, Melmed S. Pituitary adenoma or neuroendocrine tumour: the need for an integrated prognostic classification. Nat Rev Endocrinol 2023; 19:671-678. [PMID: 37592077 DOI: 10.1038/s41574-023-00883-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
In the 2022 fifth edition of the WHO Classification of Endocrine Tumours and of Central Nervous System Tumours, pituitary adenomas are reclassified as neuroendocrine tumours (NETs). This change confers an oncology label to neoplasms that are overwhelmingly benign. A comprehensive clinical classification schema is required to guide prognosis, therapy and outcomes for all patients with pituitary adenomas. Pituitary adenomas and NETs exhibit some morphological and ultrastructural similarities. However, unlike NETs, pituitary adenomas are highly prevalent, yet indolent and rarely become malignant. This Perspective presents the outcomes of an interdisciplinary international workshop that addressed the merit and clinical implications of the classification change of pituitary adenoma to NET. Many non-histological factors provide mechanistic insight and influence the prognosis and treatment of pituitary adenoma. We recommend the development of a comprehensive classification that integrates clinical, genetic, biochemical, radiological, pathological and molecular information for all anterior pituitary neoplasms.
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Affiliation(s)
- Ken K Y Ho
- The Garvan Institute of Medical Research, Sydney, New South Wales, Australia.
- The University of New South Wales, Sydney, New South Wales, Australia.
| | - Ursula B Kaiser
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Phillippe Chanson
- Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Monica Gadelha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lynnette Nieman
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | | | - Manish K Aghi
- University of California, San Francisco, San Francisco, CA, USA
| | - Lori Raetzman
- University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Kalmon Post
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gerald Raverot
- Hospices Civils de Lyon, Groupement Hospitalier Est, Université Claude Bernard Lyon 1, Bron, France
| | | | | | - Justo P Castaño
- Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | | | | | - Jill Sisco
- The Acromegaly Community, Grove, OK, USA
| | - Laura Esserman
- University of California, San Francisco, San Francisco, CA, USA
| | - Kevin C J Yuen
- Barrow Neurological Institute, Phoenix, AZ, USA
- University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA
| | - Martin Reincke
- Klinikum der Universität, Ludwig-Maximilians-Universität, München, Germany
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Lupold SE, Isaacs WB, Luo J. Aggravated Androgen Receptor Activity in Otherwise Indolent Prostate Cancer. Eur Urol 2023; 84:461-462. [PMID: 37635043 DOI: 10.1016/j.eururo.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Shawn E Lupold
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - William B Isaacs
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jun Luo
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hang J, Hao Y, Zhang S, Xu L, Zhang Q, Guo H. Validation of Epstein criteria and development of a nomogram for active surveillance in a contemporary Chinese population. Urol Oncol 2023; 41:388.e9-388.e16. [PMID: 37481463 DOI: 10.1016/j.urolonc.2023.05.001] [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: 11/24/2022] [Revised: 03/27/2023] [Accepted: 05/04/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To evaluate the Epstein criteria for insignificant prostate cancer (CaP) prediction in a contemporary Chinese population, and to develop a risk model with combined clinical and systematic biopsy and targeted biopsy parameters for active surveillance. METHODS A total of 249 CaP patients with biopsy Gleason score (GS) of 6 were included. One hundred and one patients were eligible for insignificant CaP on final pathology (GS ≤6 and organ-confined). Diagnostic tests were used to validate the ability of the 2 Epstein criteria. Univariate and multivariate regression analyses were performed to identify predictors of insignificant CaP for the development of predictive models. Receiver operating characteristics analysis was used to select the best model, followed by risk nomogram construction and internal validation. RESULTS There were 47 patients met EC1 and 61 met EC2, with pathological upgrading rates of 36% and 41%, respectively, and 70% (71/101) and 64% (65/101) were missed, with areas under the curve of 0.591 and 0.594, respectively. Four prediction models were developed using regression analysis, and model 2 incorporating age, prostate-specific antigen density, maximum percentage of core involvement at systematic biopsy, and percentage of positive cores at targeted biopsy showed the best diagnostic value (area under the curve = 0.731, sensitivity 62.4%, specificity 77.0%) and was used to construct the nomogram. Calibration curves and decision curve analysis demonstrated favorable calibration (mean absolute error 0.048) and clinical benefits of the novel nomogram. CONCLUSION The Epstein criteria need to be revised by incorporating targeted biopsy parameters to improve diagnostic performance, and a novel nomogram was developed with better prediction of insignificant CaP.
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Affiliation(s)
- Junke Hang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Hao
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, Jiangsu, China
| | - Shiwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China
| | - Linfeng Xu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China
| | - Qing Zhang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Institute of Urology, Nanjing University, Nanjing, Jiangsu, China.
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Semsarian CR, Ma T, Nickel B, Barratt A, Varma M, Delahunt B, Millar J, Parker L, Glasziou P, Bell KJL. Low-risk prostate lesions: An evidence review to inform discussion on losing the "cancer" label. Prostate 2023; 83:498-515. [PMID: 36811453 PMCID: PMC10952636 DOI: 10.1002/pros.24493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Active surveillance (AS) mitigates harms from overtreatment of low-risk prostate lesions. Recalibration of diagnostic thresholds to redefine which prostate lesions are considered "cancer" and/or adopting alternative diagnostic labels could increase AS uptake and continuation. METHODS We searched PubMed and EMBASE to October 2021 for evidence on: (1) clinical outcomes of AS, (2) subclinical prostate cancer at autopsy, (3) reproducibility of histopathological diagnosis, and (4) diagnostic drift. Evidence is presented via narrative synthesis. RESULTS AS: one systematic review (13 studies) of men undergoing AS found that prostate cancer-specific mortality was 0%-6% at 15 years. There was eventual termination of AS and conversion to treatment in 45%-66% of men. Four additional cohort studies reported very low rates of metastasis (0%-2.1%) and prostate cancer-specific mortality (0%-0.1%) over follow-up to 15 years. Overall, AS was terminated without medical indication in 1%-9% of men. Subclinical reservoir: 1 systematic review (29 studies) estimated that the subclinical cancer prevalence was 5% at <30 years, and increased nonlinearly to 59% by >79 years. Four additional autopsy studies (mean age: 54-72 years) reported prevalences of 12%-43%. Reproducibility: 1 recent well-conducted study found high reproducibility for low-risk prostate cancer diagnosis, but this was more variable in 7 other studies. Diagnostic drift: 4 studies provided consistent evidence of diagnostic drift, with the most recent (published 2020) reporting that 66% of cases were upgraded and 3% were downgraded when using contemporary diagnostic criteria compared to original diagnoses (1985-1995). CONCLUSIONS Evidence collated may inform discussion of diagnostic changes for low-risk prostate lesions.
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Affiliation(s)
- Caitlin R. Semsarian
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Tara Ma
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Brooke Nickel
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Murali Varma
- Department of Cellular PathologyUniversity Hospital of WalesCardiffUK
| | - Brett Delahunt
- Wellington School of Medicine and Health SciencesUniversity of OtagoWellingtonNew Zealand
| | - Jeremy Millar
- Alfred Health Radiation Oncology, The AlfredMelbourneAustralia
| | - Lisa Parker
- Charles Perkins Centre, Sydney School of Pharmacy, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Department of Radiation OncologyRoyal North Shore HospitalSt LeonardsAustralia
| | - Paul Glasziou
- Institute for Evidence‐Based Healthcare, Faculty of Health Sciences and MedicineBond UniversityGold CoastAustralia
| | - Katy J. L. Bell
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
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Netto GJ, Amin MB, Compérat EM, Gill AJ, Hartmann A, Moch H, Menon S, Raspollini MR, Rubin MA, Srigley JR, Hoon Tan P, Tickoo SK, Tsuzuki T, Turajlic S, Cree I, Berney DM. Prostate Adenocarcinoma Grade Group 1: Rationale for Retaining a Cancer Label in the 2022 World Health Organization Classification. Eur Urol 2023; 83:301-303. [PMID: 36202687 DOI: 10.1016/j.eururo.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
Abstract
We present the rationale for keeping the "cancer" label for grade group 1 (GG1) prostate cancer. Maintaining GG1 as the lowest grade outweighs the potential benefits that a benign designation may bring. Patient and surgeon education on the vital role of active surveillance for GG1 cancers and avoidance of overtreatment should be the focus rather than such a drastic change in nomenclature.
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Affiliation(s)
- George J Netto
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Urology, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Eva M Compérat
- Department of Pathology, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Anthony J Gill
- Sydney Medical School, University of Sydney, Sydney, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia; Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Santosh Menon
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Maria R Raspollini
- Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | - Mark A Rubin
- Department for BioMedical Research, Bern Center for Precision Medicine, University of Bern and Inselspital, Bern, Switzerland
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakut, Japan
| | - Samra Turajlic
- Francis Crick Institute and Royal Marsden NHS Foundation Trust, London, UK
| | - Ian Cree
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Daniel M Berney
- Barts Cancer Institute, Queen Mary University of London and Department of Cellular Pathology, Barts Health NHS Trust, London, UK
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Baboudjian M, Rouprêt M, Ploussard G. Redefining Gleason 6 Prostate Cancer Nomenclature: The Surgeon's Perspective. J Clin Oncol 2023; 41:1492-1493. [PMID: 36459674 DOI: 10.1200/jco.22.01621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Michael Baboudjian
- Michael Baboudjian, MD, Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France; Morgan Rouprêt, MD, PhD, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France; and Guillaume Ploussard, MD, PhD, Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Morgan Rouprêt
- Michael Baboudjian, MD, Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France; Morgan Rouprêt, MD, PhD, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France; and Guillaume Ploussard, MD, PhD, Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - Guillaume Ploussard
- Michael Baboudjian, MD, Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France; Morgan Rouprêt, MD, PhD, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France; and Guillaume Ploussard, MD, PhD, Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
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Zhou M, Amin A, Fine SW, Rao P, Siadat F, Shah RB. Should grade group 1 prostate cancer be reclassified as "non-cancer"? A pathology community perspective. Urol Oncol 2023; 41:62-64. [PMID: 36428166 DOI: 10.1016/j.urolonc.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
Overdiagnosis and overtreatment of Grade Group 1 (GG 1) prostate cancer remains a significant health care problem despite of its improved risk assessment and uptake in conservative management. Removing the cancer label from these non-lethal cancers has been proposed as an expedient way to reduce potential physical, psychological and financial harm to patients. Such a nomenclatural change necessitates a multidisciplinary team effort by clinicians and pathologists. Genitourinary Pathology Society recently conducted a survey of its members, gauging their awareness of this controversy and their position on whether GG 1 prostate cancer should be reclassified. Most respondents (196, 81.7%) opposed removing the cancer label from GG 1 cancer, 33 (13.8%) supported a change in nomenclature, while 11 (4.6%) responded that they were uncertain. Of those who supported the reclassification, 17 (51.5%) supported the change for radical prostatectomy only, 4 (12.1%) for biopsy only, and 12 (36.4%) for both biopsy and radical prostatectomy. This survey results highlight the gap between pathologists and clinicians in whether GG 1 prostate cancer should be labeled as "non-cancer," and calls for continued debates and conversations between pathologists and clinicians, and further studies on the biology, diagnostic reproducibility, and ideal management of GG 1 prostate cancer in order to make a more evidence-based decision for patients.
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Affiliation(s)
- Ming Zhou
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA.
| | - Ali Amin
- Department of Pathology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Samson W Fine
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Priya Rao
- Department of Pathology and Laboratory Medicine, University of Calgary and Alberta Precision Laboratories, Rockyview General Hospital, Calgary, AB
| | - Farshid Siadat
- Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajal B Shah
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
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Baboudjian M, Roumiguié M, Peltier A, Oderda M, Barret E, Fromont G, Dariane C, Fiard G, Charvet AL, Gondran-Tellier B, Durand-Labrunie C, Campello PV, Roumeguère T, Diamand R, Diana P, Touzani A, Beauval JB, Daniel L, Rouprêt M, Ruffion A, Ploussard G. Grade group 1 prostate cancer on biopsy: are we still missing aggressive disease in the era of image-directed therapy? World J Urol 2022; 40:2423-2429. [PMID: 35980449 DOI: 10.1007/s00345-022-04130-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Recently, Eggener et al. reignited a debate consisting to redefine Gleason Grade Group (GGG) 1 prostate cancer (PCa) as a precancerous lesion to reduce overdiagnosis and overtreatment. However, historical cohorts showed that some GGG1-labeled disease at biopsy may be underestimated by the standard PCa diagnostic workup. The aim was to assess whether the risk of adverse features at radical prostatectomy (RP) in selected GGG1 patients still exists in the era of pre-biopsy mpMRI and image-guided biopsies. METHODS We retrospectively reviewed our data from a European RP dataset to assess in contemporary patients with GGG1 at mpMRI-targeted biopsy the rate of adverse features at final pathology, defined as ≥ pT3a and/or pN+ and/or GGG ≥ 3. RESULTS A total of 419 patients with cT1-T2 cN0 GGG1-PCa were included. At final pathology, 143 (34.1%) patients had adverse features. In multivariate analysis, only unfavorable intermediate-risk/high-risk disease (defined on PSA or stage) was predictive of adverse features (OR 2.45, 95% CI 1.11-5.39, p = 0.02). A significant difference was observed in the 3-year biochemical recurrence-free survival between patients with and without adverse features (93.4 vs 87.8%, p = 0.026). In sensitivity analysis restricted low- and favorable intermediate-risk PCa, 122/383 patients (31.8%) had adverse features and no preoperative factors were statistically associated with this risk. CONCLUSION In this European study, we showed that there is still a risk of underestimating GGG1 disease at biopsy despite the routine use of image-guided biopsies. Future studies are warranted to improve the detection of aggressive disease in GGG1-labeled patients by incorporating the latest tools such as genomic testing or radiomics.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France.
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France.
| | - Mathieu Roumiguié
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | - Alexandre Peltier
- Department of Urology, Hôpital Universitaire de Bruxelles, Jules Bordet Institute and Erasme Hopsital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marco Oderda
- Division of Urology, Department of Surgical Sciences-Urology, Città Della Salute e della Scienza di Torino-Molinette Hospital, University of Turin, Turin, Italy
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, ParisParis University-U1151 Inserm-INEM, Necker, Paris, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | - Anne-Laure Charvet
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | | | | | - Thierry Roumeguère
- Department of Urology, Hôpital Universitaire de Bruxelles, Jules Bordet Institute and Erasme Hopsital, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Hôpital Universitaire de Bruxelles, Jules Bordet Institute and Erasme Hopsital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alae Touzani
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | | | - Laurent Daniel
- Department of Pathology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013, Paris, France
| | - Alain Ruffion
- Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon,, Lyon, France
- Equipe 2-Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud-Université Lyon 1, Lyon, France
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