Subtyping the Risk of Intermediate Risk Prostate Cancer for Active Surveillance Based on Adverse Pathology at Radical Prostatectomy

Abstract

Adverse pathology at radical prostatectomy was observed at a threefold higher rate in patients classified at favorable intermediate risk compared to low risk, leading to worse overall survival. Men at intermediate risk may be better classified as types 1 and 2 since none showed pathological outcomes similar to those of men at low risk.

Downgrading of grade group 2 intermediate‐risk prostate cancer from biopsy to radical prostatectomy: Comparison of outcomes and predictors to identify potential candidates for active surveillance

“…However, recent data from AS programs suggest that IR patients have worse outcomes on AS than LR patients, likely due to the presence of GG2 disease . Furthermore, analyses of a patient cohort at our institution and subsequently a national patient sample demonstrated that compared with patients at LR, those at IR—regardless of risk stratification by individual variables—are several times more likely to harbor adverse pathological findings at RP, which in turn are predictive of worse survival . While previous efforts using cutoffs for separate variables in preoperative risk stratification have failed to identify a subset of biopsy IR patients who may be able to consider AS, our developed multivariable logistic regression model to predict the risk of pathological downgrading has identified a subset of biopsy GG2 IR patients with similar outcomes after RP to biopsy LR patients.…”

“…6,7 However, to our knowledge, there are no data to identify a subset of IR patients who will have a similar outcome on AS to patients at LR. In fact, adverse surgical pathological findings at radical prostatectomy (RP) are several times more likely in IR patients regardless of the definition used 8,9 and are predictive of worse survival. 5,9 Moreover, pathological downgrading or upgrading can occur from biopsy to RP, [10][11][12] further complicating the choice of treatment.…”

“…In fact, adverse surgical pathological findings at radical prostatectomy (RP) are several times more likely in IR patients regardless of the definition used 8,9 and are predictive of worse survival. 5,9 Moreover, pathological downgrading or upgrading can occur from biopsy to RP, [10][11][12] further complicating the choice of treatment. The grade group (GG) that is assigned at biopsy may not be the same as that at RP due to pathology errors, borderline grades, and sampling errors.…”

“…5,19 Furthermore, analyses of a patient cohort at our institution and subsequently a national patient sample demonstrated that compared with patients at LR, those at IR-regardless of risk stratification by individual variables-are several times more likely to harbor adverse pathological findings at RP, which in turn are predictive of worse survival. 8,9 While previous efforts using cutoffs for separate variables in preoperative risk stratification have failed to identify a subset of biopsy IR patients who may be able to consider AS, our developed multivariable logistic regression model to predict the risk of pathological downgrading has identified a subset of biopsy GG2 IR patients with similar outcomes after RP to biopsy LR patients. Therefore, predicting individual patient risk for pathological downgrading or upgrading with a multivariable risk calculator during the shared decision-making process may be more beneficial than creating strict cutoffs for unidimensional variables.…”

LacdiNAc-Glycosylated Prostate-specific Antigen Density is a Potential Biomarker of Prostate Cancer

“…Recently, several studies reported that patients with PCa evaluated through biopsy and clinical evaluation with a GG of 2 and favorable intermediate risk harbored a higher grade and stage disease, suggesting that these patients are poor candidates for active surveillance. [25][26][27] Yang et al reported that approximately 1 in 3 of these patients harbored a disease of higher grade or stage. 28 In light of these results, patients with a GG1-graded biopsy would be better candidates than patients with a GG2-graded biopsy for active surveillance instead of curative therapies.…”