New research has highlighted the challenges of diagnosing prostate cancer accurately, balancing the risks of overdiagnosis and underdiagnosis.
Some experts have suggested reclassifying the lowest grade of prostate cancer, known as biopsy Gleason Grade Group (GGG) 1, as “benign.”
However, a recent study led by Mass General Brigham researchers suggests that many patients with GGG1 may actually have more aggressive cancer than initially thought.
By analyzing data from over 10,000 patients at a university in Germany, researchers discovered that at least 8% of patients classified with GGG1 had a more aggressive form of prostate cancer.
They also found that many high-risk GGG1 patients could be identified by high PSA levels or if 50% or more of their biopsy samples tested positive for cancer.
Continuing to classify these high-risk patients as having cancer could improve their treatment plans and reduce the risk of death.
The study’s results were published in European Urology Oncology.
“Our study identifies two risk factors that help determine which patients with GGG1 are at heightened risk of aggressive disease and death,” said senior author Dr. Anthony D’Amico of the Department of Radiation Oncology at Brigham and Women’s Hospital.
“For high-risk GGG1 patients, we should continue to call their diagnosis cancer and report it to their physician for appropriate action. For low-risk GGG1 patients, the chance of dying is much lower.
But for clinicians treating high-risk patients, our message is clear: Call it cancer, and look harder.”
Dr. D’Amico and his colleagues from University Hospital Hamburg Eppendorf analyzed data from 10,228 GGG1 prostate cancer patients who underwent radical prostatectomy (surgical removal of the prostate) in Germany. Of these, 9,249 were diagnosed using transrectal ultrasound (TRUS)-guided biopsies, while 980 were diagnosed using a combination of TRUS and MRI for more accurate detection.
The study, which began in February 1992 and continued through November 2023, found that adverse pathology—a higher-grade Gleason Group Score or positive pelvic lymph nodes—was present in 10.33% of patients diagnosed with TRUS alone and 7.86% of those diagnosed using the combined approach.
About 6% of GGG1 patients had a PSA level of 20 ng/ml or more, and 12–14% had more than half of their biopsy samples return positive results. These patients had a significantly higher risk of aggressive cancer, early PSA failure, and death.
While the study’s population came from a single institution and included some older diagnostic methods, the findings consistently showed which factors predict increased risk of aggressive cancer.
Dr. D’Amico suggests that for high-risk GGG1 patients, clinicians should consider follow-up biopsies or genomic testing to detect aggressive cancer early. This approach allows for informed discussions between physicians and patients about whether to observe, actively surveil, or treat the condition.
“Labeling all GGG1 patients as ‘benign’ could prevent these crucial conversations from happening,” he noted.
This study emphasizes the importance of accurately identifying and treating high-risk prostate cancer patients to improve outcomes and reduce mortality.
If you care about prostate cancer, please read studies about 5 types of bacteria linked to aggressive prostate cancer, and new strategy to treat advanced prostate cancer.
For more information about prostate cancer, please see recent studies about new way to lower risk of prostate cancer spread, and results showing three-drug combo boosts survival in metastatic prostate cancer.
