Part 3: Prostate Cancer Risk Assessment
By: Dan Sperling, MD. While PSA screening has undeniably lowered the death rate from prostate cancerthere is another side to the coin. Without the tools to determine with confidence which cell lines will pose no long-term threat, medicine has erred to the side of caution, because untreated malignancies are assumed to proliferate and colonize other structures and organs.
Therefore, the standard of care has been to treat all prostate tumors aggressively. Countless patients have thus been overtreated; for many this has resulted in impaired personal quality of life due to urinary, sexual or bowel side effects.
With increasing evidence that certain Gleason 6 cell lines do not appear to progress to Gleason 7, some experts are asking whether they are true malignancies. At issue is whether Gleason 6 prostate cancer has the potential to become more aggressive to the point where the cells can proliferate locally and metastasize to remote locations, and if so, how soon will this occur after the initial biopsy.
For this reason, patients who go on AS have PSA tests at regular intervals within a year and are urged to have undergo repeat TRUS biopsy at least at the end of the first year to monitor for progression. At the first sign of progression, patients will be offered treatment—though not all will pursue it at that point. Here are examples from the published literature illustrating various aspects of the dilemma:.
Is this due to inaccurate biopsy results the first acinar adenocarcinoma della prostata Gleason score 3, or did the tumor actually mutate in a more aggressive direction?
One final publication sheds light on focal treatment as a middle ground between radical therapy with the risk of urinary and sexual side effects and AS with the risk of tumor progression and possibly missing a treatment window. However, focal therapy represents a middle ground that complements AS, especially for men with higher disease acinar adenocarcinoma della prostata Gleason score 3 factors.
Focal therapy technologies include cryotherapy freezingHIFU and acinar adenocarcinoma della prostata Gleason score 3, as well as some novel technologies mostly used in countries other than the U.
Despite lack of long term data, focal laser ablation appears to offer competitive cancer control while having the least risk of side effects. Cancer Network Review Article. Diagn Pathol. Untreated Gleason grade progression on serial acinar adenocarcinoma della prostata Gleason score 3 during prostate cancer active surveillance: clinical course and pathological outcomes. J Urol. Anticancer Res. Management of low risk prostate cancer-active surveillance and focal therapy. Nat Rev Clin Oncol.
Epub May acinar adenocarcinoma della prostata Gleason score 3 Here are examples from the published literature illustrating various aspects of the dilemma: An Italian case study is a cautionary tale that begins by acknowledging the debate on Gleason 6 being labeled as cancer.
He was treated with prostatectomy. However, the pathologist also found cancer cells in nearby blood and lymph vessels lymphovascular invasion and one positive lymph node close to the prostate gland. Most clinicians consider this a poor prognostic factor because the tumor is aggressively invasive and has left the gland.
His disease was upstaged to T3a and the tumor upgraded to reflect a tertiary Gleason pattern 4. All of the patients were eventually upgraded, average follow-up 23 months. The authors concluded since very few men were further upgraded at surgery, delaying treatment was not associated with adverse outcomes. However, the Hussein et al. The next study is testing a way to qualify acinar adenocarcinoma della prostata Gleason score 3 for AS with greater confidence.