When a GS6 can be more than a GS6…

In the current issue of the Journal of Urology there is an article by Swedish researchers who investigated low-risk prostate cancer among men diagnosed with PCa in the recent past (2007 – 2011).

In those 5 years some 45,532 men in Sweden were diagnosed with various stages of prostate cancer. Of those, 17,437 (38.3%) were diagnosed with GS6. The objective of the researchers (Stattin P et al) was to clearly identify those low-risk PCa men that qualified for active surveillance (AS). Because of certain limitations, only 13,159 (28.9%) of the GS6 patients met the AS guidelines and of those low-risk patients, 4,500 chose radical prostatectomy. These surgically treated men were younger (median age 62) and had smaller prostate glands (median volume 35 ml) and a median PSA of 6.1 ng/ml.

“Results
Among Swedish men with clinically localized Gleason 6 prostate cancer approximately 50% had adverse pathology at radical prostatectomy. Of the men who met the study inclusion criteria of 6 different active surveillance protocols, adverse pathology was present in 33% to 45%. Predictors of adverse pathology were older age, higher prostate specific antigen, prostate specific antigen density greater than 0.15 ng/ml/cm3, palpable disease and extent of cancer greater than 4 mm on biopsy. Larger prostate volume had an inverse relationship with adverse pathology.”

As you can see these results are important for men here who contemplate doing AS. These results could affect all low-risk men treated with forms of treatment other than surgery too.

In reviewing this article:
1. The number of low-risk cancer patients diagnosed is clearly related to the use of PSA in a population.
2. In Sweden the use of PSA testing is not as high as it is in the USA
3. With reduced PSA testing there is more advanced disease at diagnosis. This is not a good thing.
4. This is one of the reasons Sweden has one of the highest prostate cancer mortality in the World.

AS should be the main strategy to avoid over treatment. Until better diagnostics are available men need to be careful in avoiding treatment while avoiding progression. To promote AS without more accurate information simply because GS6 will never or hardly ever progress is a disservice to uninformed patients. The fact that the results of this Swedish study show more advanced disease at diagnosis is an indication that in the absence or reduced PSA testing PCa can progress to more lethal forms of the disease. This should be well understood by all men as they age…

RalphV

Source:
Stattin P et al.
Population Based Study of Predictors of Adverse Pathology among Candidates for Active Surveillance with Gleason 6 Prostate Cancer. The Journal of Urology,Volume 191, Issue 2 , Pages 350-357, February 2014

Ralf,

As usual, you are right on target, very well presented, and I am with you on this.

David

and they wonder why so many guys opt for treatment.

ed

RalphV,

Good post. As per my signature, I seem to be a perfect example of what the author discovered. I know I made the right choice though others with similar biopsy results might have opted for AS.

Ralph, I was just thinking the other day that it had been a while since I'd seen any posts by you.  I always look forward to your insights, and have yet to find a comment with which I disagree.  Bill