Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

JU INSIGHT Active Surveillance After Biopsy Reclassification to Grade Group 2 Prostate Cancer

By: Ezra Baraban, MD, Johns Hopkins Hospital, Baltimore, Maryland; Eric Erak, MD, Johns Hopkins Hospital, Baltimore, Maryland; Aisha Fatima, MD, Johns Hopkins Hospital, Baltimore, Maryland; Amir Akbari, MD, Johns Hopkins Hospital, Baltimore, Maryland; Jianping Zhao, MD, PhD, Johns Hopkins Hospital, Baltimore, Maryland; Sean A. Fletcher, MD, Johns Hopkins Hospital, Baltimore, Maryland; Yasin Bhanji, MD, Johns Hopkins Hospital, Baltimore, Maryland; Claire M. de la Calle, MD, Johns Hopkins Hospital, Baltimore, Maryland; Mufaddal Mamawala, MBBS, MPH, Johns Hopkins Hospital, Baltimore, Maryland; Patricia Landis, Johns Hopkins Hospital, Baltimore, Maryland; Katarzyna J. Macura, MD, PhD, Johns Hopkins Hospital, Baltimore, Maryland; Christian P. Pavlovich, MD, Johns Hopkins Hospital, Baltimore, Maryland; Jonathan I. Epstein, MD, Johns Hopkins Hospital, Baltimore, Maryland | Posted on: 20 Jul 2023

Baraban E, Erak E, Fatima A, et al. Identifying men who can remain on active surveillance despite biopsy reclassification to grade group 2 prostate cancer. J Urol. 2023;210(1):99-107.

Study Need and Importance

Men on active surveillance (AS) with grade group (GG) 1 prostate cancer who reclassify to GG2 on surveillance biopsy often leave AS. However, there are limited data available to guide this difficult decision. We aimed to identify subgroups of men who can safely remain on AS despite reclassification to GG2.

What We Found

Fifty-seven percent of men who were reclassified to GG2 on biopsy after entering AS with GG1 disease showed favorable pathological findings at prostatectomy. Perineural invasion and PSA density were significant risk factors for adverse pathology at radical prostatectomy among GG1 AS patients as well as in patients reclassified to GG2 while on AS. Multivariable regression based on PSA density and perineural invasion demonstrated that GG2 patients with low PSA density and without perineural invasion have lower risk for adverse pathology at prostatectomy than GG1 patients with these risk factors (see Figure). Therefore, reclassification to GG2 alone should not disqualify men from continuing on AS, particularly in the absence of other worrisome clinical, radiographic, or pathological findings such as percent Gleason pattern 4 approaching 50%, large cribriform morphology, or intraductal carcinoma.

Figure. Predicted risk of adverse pathology at radical prostatectomy (RP) in grade group 1 patients (A) and in patients reclassified to grade group 2 (B) stratified by perineural invasion (PNI) using multivariable regression model incorporating PNI and prostate-specific antigen (PSA) density.

Limitations

Findings are limited by the retrospective and single-institution design of the study. While MRI Prostate Imaging Reporting & Data System score was not a significant risk factor for adverse pathology in our cohort, evaluation is limited as the majority of the cohort preceded routine clinical MRI use.

Interpretation for Patient Care

Patients reclassified to GG2 while on AS should not reflexively leave AS and undergo definitive treatment. In the absence of other worrisome findings, patients with low PSA density and without perineural invasion are particularly suitable candidates for remaining on AS despite reclassification to GG2.

advertisement

advertisement