Grade group 1 prostate cancer on biopsy: are we still missing aggressive disease in the era of image-directed therapy?

A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy. Letter.

“…1 Ebbing et al concluded that ischemia time was an independent factor for acute renal insufficiency in patients submitted to partial nephrectomy but there was no impact on long-term function. 2 Our study had 15% of zero ischemia in the laparoscopic partial nephrectomy group vs 35% in the open partial nephrectomy group, with a median ischemia time of 14 minutes (7-25 minutes) for both groups, demonstrating the hypothesis that ischemia time has a shorter impact in long-term renal function. 3 We believe that image magnification of laparoscopy led the surgeon to perform a better enucleation of the tumor, preserving more healthy tissue.…”

“…So, why should a urologist want to employ CI? The transplant literature (WI beyond 25 minutes results in long lasting diffuse renal damage), [2][3][4] the trauma literature (not dead until warm and dead), and the anatrophic nephrolithotomy surgery studies by Smith and Boyce 5 all support CI over WI in terms of functional organ preservation. The 2 most widely cited renal ischemia studies report WI beyond 20-25 minutes results in chronic diffuse damage to the kidney, whereas CI for up to 58 minutes prevented ischemic injury to the renal remnant.…”

“…These results are in accordance with a recent study that we conducted on behalf of the French Prostate Cancer Committee of the Association Franc ¸aise d'Urologie. 2 Among 419 GGG 1 PCa patients, 143 (34.1%) patients had adverse features (defined as !pT3a and/or pNþ and/or GGG !3). The risk of adverse features was not associated with the number of positive cores (P [ .2), the percentage of positive cores (P [ .3), the number of positive targeted cores (P [ 1), nor in case of bilateral positivity (P [ .9).…”

Risk stratification for early biochemical recurrence of prostate cancer in the era of multiparametric magnetic resonance imagining‐targeted biopsy

“…More specifically, 91/175 (52%) of low‐risk patients according to EAU risk groups in the present study were reclassified as intermediate‐risk only because of the maximum diameter of index lesion (i.e., 10–20 mm) and 22/175 (13%) as high‐risk because of the maximum diameter of index lesion (i.e., >20 mm) or MRI stage (i.e., extraprostatic extension at MRI). The prognostic role of preoperative MRI features and the risk of adverse pathology at final pathology for patients harboring ISUP grade group 1 (i.e., low‐risk patients) are well known, supporting this change in the distribution of patients 21,22 . Conversely, the implementation of MRI in the diagnostic pathway induced a stage/grade migration due to the Will Rogers effect and improved the detection of csPCa with favorable prognostic over systematic biopsy 3 .…”

Gleason Grade 1 Prostate Cancer Volume at Biopsy Is Associated With Upgrading, but Not Adverse Pathology or Recurrence After Radical Prostatectomy: Results From a Large Institutional Cohort. Letter.

“…These results are in accordance with a recent study that we conducted on behalf of the French Prostate Cancer Committee of the Association Française d’Urologie. 2 Among 419 GGG 1 PCa patients, 143 (34.1%) patients had adverse features (defined as ≥pT3a and/or pN+ and/or GGG ≥3). The risk of adverse features was not associated with the number of positive cores ( P = .2), the percentage of positive cores ( P = .3), the number of positive targeted cores ( P = 1), nor in case of bilateral positivity ( P = .9).…”