THE CLASSIFICATION of biopsy Gleason Grade Group (GGG) 1 as cancer remains controversial, as previous trials have shown a low rate of patients with GGG1 dying from prostate cancer (PC) after a median follow-up of 15 years. However, a new study led by Derya Tilki, Martini-Klinik Prostate Cancer Center, Hamburg, Germany, has suggested that many patients with a biopsy result of GGG1 might have a more aggressive form of cancer than their biopsy indicates.
The study, which analysed data from 10,228 patients, found that at least 8% of patients with GGG1 had a more aggressive form of PC. Patients with high prostate-specific antigen (PSA) levels or a high percentage of positive biopsy samples were identified as having the highest risk. Maintaining a cancer classification for these high-risk patients could improve their treatment plans and reduce mortality.
Among the 10,228 patients, adverse pathology, defined as a higher-grade Gleason Group Score or positive pelvic lymph nodes, was found in 10.33% of patients diagnosed using a transrectal ultrasound scan (TRUS) and 7.86% of patients diagnosed with the combined approach. The contemporary combined biopsy (CBx) approach involves TRUS-guided systematic biopsy (SBx) in addition to multiparametric MRI/TRUS fusion-guided biopsy.
Results showed that 10.33% of patients diagnosed using SBx and 7.86% of patients diagnosed using CBx had adverse pathology at the time of radical prostatectomy. Factors such as older age, over 50% positive biopsy samples, PSA levels above 20 ng/ml, and Stage 2 disease significantly increased the risk of adverse pathology. Approximately 6% of patients with GGG1 had PSA levels of 20ng/ml or higher, and 12-14% had more than half of their biopsies return positive results. These patients had significantly higher risks of adverse pathology, early PSA failure, and death.
The CBx method is now in use; however, there is insufficient data on whether clinical parameters can predict high-risk PC in patients initially diagnosed with GGG1 via this method. This new research underscores the difficulty in balancing the risks of over-diagnosing and under-diagnosing PC early enough to reduce mortality, while also highlighting the importance of further testing for patients with these risk factors to ensure timely intervention which could lead to enhanced patient outcomes.
Katie Wright, EMJ
Reference
Tilki D et al. Mortality risk for patients with biopsy Gleason grade group 1 prostate cancer. Eur Urol Oncol. 2024;DOI:10.1016/j.euo.2024.06.009.
