For years urologists have been aware of the “upgrading” of the Gleason’s score when comparing the biopsy report with the final pathology report. The tricky thing here is that the urologist and the “surveillance minded” patient are making decisions about surveillance on limited information, i.e. the biopsy report. ( Think of twelve cores about twice the width of a hair taken from a lemon which may or may not give you the true indication of the nature of your prostate cancer.) What is nice about the below and other studies is that of the people who progressed, no harm seems to be done with the delay in treatment. (Putting off the inevitable comes to mind for some of these patients.) As I have said it takes a certain mindset to agree to pursue surveillance. One is living with the known diagnosis of cancer, and is subjected usually to twice a year PSA’s and a yearly biopsy. If you are that percent that delayed treatment for a year or so….would that be worth it to you. As my mother said….”to each his own.” By the way… I encourage surveillance for the patient that meets the criteria and has the mind for it.
Epidemiology
Last Updated: 2011-06-01 16:04:17 -0400 (Reuters Health)
By Dave Levitan
NEW YORK (Reuters Health) – Changes in Gleason score are common during active surveillance for prostate cancer, a new paper says.
About 25% of such men will have subsequent negative biopsies and about 35% will have an upgrade, said lead author Dr. Sima Porten of the University of California, San Francisco, in an e-mail to Reuters Health.
Until now, not much was known about biopsy changes in men who opt for active surveillance, Dr. Porten and colleagues write in their report, published online May 31 in the Journal of Clinical Oncology.
The new study involved 377 men undergoing active surveillance. Ninety-four percent had an initial Gleason score of 6 or less, and 6% had a score of 7 (either 3 + 4 or 4+3).
The mean time to follow-up after the initial biopsy was 54 months. At the first repeat biopsy, 81 men (21%) had an upgraded Gleason score; 91 (24%) had a negative finding, 198 (53%) had no change, and seven men (2%) were downgraded.
Of the 198 with no change after the second biopsy, only 24 were upgraded after a third. Of the 69 men who showed no change until a fourth biopsy, six men then experienced an upgrade. Nearly all the men who had progression on biopsy — 98% — were upgraded to Gleason 3 + 4 disease.
Of the 91 who had a negative second biopsy, 19 (21%) had a positive finding on a third biopsy. Thirteen of 43 (30%) had cancer discovered on a fourth biopsy.
Fifty-nine percent of men with upgraded score opted for definitive treatment, though the authors noted they haven’t been following the men long enough to make definitive statements on treatment outcomes. Still, Dr. Porten suggests that early data indicate there may be little difference between immediate and delayed treatment.
“In individual patients, biopsy changes are fairly variable over time, but overall, men who experience an upgrade and go on to subsequent treatment have favorable outcomes and seem to be no different than those who are treated outright,” Dr. Porten said.
SOURCE: http://bit.ly/liGZW9
J Clin Oncol 2011.
Prostate Diaries 