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A recent study published in European Urology Oncology has highlighted two critical risk factors that could indicate a higher likelihood of aggressive prostate cancer. The study evaluated the mortality risks in prostate cancer (PC) patients based on the Gleason score and other clinical parameters. The Gleason score is a grading system ranging from 6 to 10 used to assess prostate cancer’s severity. A lower Gleason score suggests that the cancer cells are similar to normal cells and are likely to spread more slowly. Clinicians rely on this score to devise effective treatment plans, potentially leading to better patient outcomes.
However, the ProtecT trial findings have sparked debate over the accuracy of Gleason grade 3 + 3, or Gleason grade group (GGG) 1, results from prostate biopsy analysis. The majority of the ProtecT trial cohort had GGG 1 disease, and only 3.1% of this group died from prostate cancer after a median follow-up of 15 years. Participants in the ProtecT trial were randomly assigned to active monitoring (AM) or radical treatment, including androgen deprivation therapy (ADT), radical prostatectomy (RP), or radiotherapy (RT). By the 15th year of follow-up, about 61% of patients initially assigned to AM eventually underwent radical treatment, indicating a higher risk of developing metastatic disease.
Investigating Clinical Parameters and Their Impact
The study aimed to identify clinical parameters that could predict the presence of high-risk PC in patients initially diagnosed with GGG 1 and determine if this information could help detect patients at higher risk of prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM). The researchers examined 10,228 patients who underwent RP for biopsy-diagnosed GGG 1 adenocarcinoma of the prostate at the University Hospital Hamburg-Eppendorf. Of these, 9,248 patients had a 12-core TRUS-guided systematic biopsy (SBx), with a median age of 63 years. Additionally, a separate cohort of 980 patients who underwent RP for GGG 1 PC between July 2013 and September 2023 was analyzed, with a median age of 62 years.
Key Findings and Implications for Prostate Cancer Treatment
The study found that patients with GGG 1 PC diagnosed by contemporary combined biopsy (CBx) who had more than 50% positive biopsies (PPB) or a prostate-specific antigen (PSA) level over 20 ng/ml faced a significantly higher risk of adverse pathology at RP and early PSA failure. Patients with one or both of these clinical risk factors in the SBx group exhibited a higher risk of PCSM and ACM. If the ProtecT trial results had been stratified by these clinical factors, higher PCSM rates might have been estimated.
Considering clinical factors during diagnosis could help identify patients likely to harbor unsampled higher-grade and higher-stage cancer, potentially improving their prognosis. The study suggests that patients with biopsy-diagnosed GGG 1 PC, with either PPB >50% or PSA >20 ng/ml, should be considered for systematic rebiopsy. Early intervention with RP has been associated with reduced mortality rates for prostate cancer. Listing a GGG 1 result as benign could delay cancer diagnosis and treatment, emphasizing the importance of accurate grading and timely intervention. The study’s findings underline the need for incorporating clinical parameters to better predict long-term mortality risk and improve treatment strategies for prostate cancer patients.
