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.

You have accessJournal of UrologyLetters to the Editor1 Jan 2023Gleason 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.is a letter which has replyGleason 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. Reply. Michael Baboudjian and Guillaume Ploussard Michael BaboudjianMichael Baboudjian *Correspondence: Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille , France telephone: +33-625-314-029; E-mail Address: [email protected] Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France More articles by this author and Guillaume PloussardGuillaume Ploussard Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002991AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail J Urol. 2023:209(1):198-207. To the Editor: We read with great interest the article by Shee et al, reporting on the oncologic outcomes of radical prostatectomy in men with Gleason Grade Group (GGG) 1 prostate cancer (PCa), which was published recently in The Journal of Urology®.1 First of all, we would like to congratulate the authors for their effort in rigorously collecting and presenting very important data that will help to refine and expand patient eligibility for active surveillance (AS). AS is the way to go for all low-risk PCa patients, and the authors have demonstrated this brilliantly. Among 1,029 men included in the study, adverse pathological features (ie, defined as ≥pT3a and/or pN+ and/or GGG ≥3) were recorded in 20% of cases, and were not correlated with the percent of positive biopsy cores (ie, tumor volume at biopsy) in multivariate analysis (P = .84). 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). It is therefore a great satisfaction to see that our institutions share common research topics and similar conclusions. Our studies demonstrate that, in the era of pre-biopsy multiparametric MRI and image-guided biopsies, historical criteria such as “number of positive cores” are no longer relevant, and many patients outside of these criteria may possess low absolute risks of local or distant progression. Revisiting current recommendations may therefore help to expand patient eligibility for AS, which is one of the most important goals in the coming years. In addition to redefining very-low–risk and low-risk PCa groups, we should also investigate the criteria for selecting the best intermediate-risk candidates for AS. In a recent systematic review and meta-analysis, we showed that AS was associated with significantly higher risks of metastasis and cancer mortality in unselected patients with intermediate-risk PCa than in patients with low-risk PCa.3 In subgroup analysis, we also showed in studies excluding GGG 3 intermediate-risk patients that treatment-free survival and metastasis-free survival were similar between low- and intermediate-risk patients. However, to date, the eligibility of intermediate-risk PCa patients for AS is limited by very strict consensus-based inclusion criteria, and these recommendations have been endorsed by the American Society of Clinical Oncology.4 They include, among other criteria, again the absolute number of positive biopsies, based on a low level of evidence. We encourage multi-institutional collaborative work on this subject to prevent history from repeating itself indefinitely. References 1. . 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. J Urol. 2023: 209(1):198-207. Google Scholar 2. . Grade group 1 prostate cancer on biopsy: are we still missing aggressive disease in the era of image-directed therapy?World J Urol. 2022;doi: 10.1007/s00345-022-04130-z. Crossref, Google Scholar 3. . Active surveillance for intermediate-risk prostate cancer: a systematic review, meta-analysis, and metaregression. Eur Urol Oncol. 2022;doi: 10.1016/j.euo.2022.07.004. Crossref, Google Scholar 4. Active surveillance for the management of localized prostate cancer (Cancer Care Ontario guideline): American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2016; 34(18):2182-2190. Google Scholar Submitted September 11, 2022; accepted September 19, 2022; published October 13, 2022. https://doi.org/10.1097/JU.0000000000002991 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology13 Oct 2022Gleason 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. Reply. Volume 209Issue 1January 2023Page: 72-72 PEER REVIEW REPORTS Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Baboudjian Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France *Correspondence: Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille , France telephone: +33-625-314-029; E-mail Address: [email protected] More articles by this author Guillaume Ploussard Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France More articles by this author Expand All Submitted September 11, 2022; accepted September 19, 2022; published October 13, 2022. https://doi.org/10.1097/JU.0000000000002991 Advertisement Advertisement PDF downloadLoading ...