Renaming Grade Group 1 PCa

Not sure if you’ll be able to access this link if you are not on an iPad or iPhone or Mac as it’s from Apple news, but worth a try. We’ve heard this before an interesting concept. Doctors are talking about not referring to grade group 1 prostate cancer as cancer. Reason: So men with indolent cancers are not scared into over treatment.

https://apple.news/ay-bv94xnqaiwn7uveewuxg

Pratoman said...

Doctors are talking about not referring to grade group 1 prostate cancer as cancer. Reason: So men with indolent cancers are not scared into over treatment.
https://apple.news/ay-bv94xnqaiwn7uveewuxg

I'm always amused when this proposal comes up. The doctors babysitting some of these guys to protect them from themselves. Instead, they could tell the patients the truth and pay Will Smith to B-Slap them if they get hysterical about being a G6.

jmadrid said...
All I can say is that I am a Grade 1 updated to Grade 4 after the pathological report. I am glad I and my doctors considered I had cancer and needed treatment.

I was typing a longer reply when I saw that jmadrid summed the reality up perfectly.

The debate about whether Gleason 6 (3+3) (Grade Group 1) is cancer has been going on for many years:

Gleason Score 6 Adenocarcinoma: Should It Be Labeled As Cancer? (2012, with pioneers Partin, Walsh & Coffey among the authors)

Is Grade Group 1 (Gleason score 3 + 3 = 6) adenocarcinoma of the prostate really cancer? (2022 paper by J. Epstein)

"Abstract
Purpose of review
Whether Grade Group 1 (GG1) prostate cancer is really cancer remains controversial.

Recent findings
Favoring renaming GG1 with a noncancerous diagnosis are: fear of the term cancer, which will lead to overtreatment of GG1; and indolence of GG1. Favor designating GG1 as cancer are: morphologically, GG1 may be indistinguishable from GG2 to GG5 and GG1 is invasive (lacks basal cells), can show perineural invasion and extraprostatic extension; molecularly, GG1 has many of the hallmarks of prostate cancer; calling GG1 noncancer would lead to inconsistencies and confusion in reporting; sampling error with GG1 on biopsy can miss higher grade cancer; removing the label of cancer in men with GG1 on biopsy may make it challenging to insure follow-up during active surveillance; the prognosis of treated GG1 may not be the same if GG1 called noncancer and not treated; with Grade Group terminology, GG1 is more intuitive to patients as lowest grade cancer; and patients are increasingly adopting active surveillance, recognizing that not all prostate cancers are the same and GG1 can be followed carefully and safely on active surveillance.

Summary
There is strong support for retaining the carcinoma designation for GG1."
____________________________

As mentioned, active surveillance for G6 has been making great strides--why rock the boat?

Djin

Well, you know, there is another way. Doctors could actually spend the time and energy on education and stop doing surgery because the patient demands it.

I'm one of the 25-30% who had the upgrade from G6 to G7 between biopsy and post surgery pathology. I have the feeling--not proven of course--that if I had gone AS, I would have ended up in treatment within 6 months to a year anyway. My biopsy showed 3 positive cores, all on one side and final pathology was in all 4 quadrants in multiple lesions.

I was diagnosed with three cores of Gleason 6 in 2009. Enrolled in Johns Hopkins’ AS program that same day.

Nine MRI’s and eight biopsies later, no prostate cancer has been found since 2019.

At this point, JH plans no more MRIs or biopsies unless my PSA rises.

I know other men whose Gleason 6 PCa cannot be found.

So, while I appear to prove the point that Gleason 6 is not likely to progress, I am against changing its designation as cancer.

That is because I fear that men will fail to have the regular follow-up tests to assure that they were not under-diagnosed.

I know that I am a “true Gleason 6”. A guy with one biopsy cannot assume that they really are. They need the motivation to keep having testing, including more MRI and biopsies.

there they go again

The experts only figured out that I was a 3+4 at the 4th biopsy. By that time it has already grown outside the capsule. Surgical margin was super close (malignancy abutted the margin) but was claimed to be negative. My guess is that the grade 4 was always there. But due to the hit or miss approach, it wasn't found until #4. Probably in a section of the prostate that is hard to reach by the needle. The path report indicated that the malignancy only covered about 5% of the gland. Thankfully, while on active surveillance, they had me come in annually for a follow-up biopsy. No worries though. So far, it turned out fine. Knock on wood.