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Defining the threshold for significant versus insignificant prostate cancer
Theo H Van der Kwast1, Monique J Roobol
1Department of Laboratory Medicine and Pathobiology, University of Toronto, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. theodorus.vanderkwast@uhn.ca
Nature Reviews. Urology
|May 29, 2013
Summary
Active surveillance for prostate cancer is crucial for avoiding overtreatment. Current definitions of insignificant prostate cancer may be too restrictive, potentially excluding eligible men from this approach.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Autopsy studies reveal a significant reservoir of latent prostate cancers in adult men.
- Serum prostate-specific antigen (PSA) testing detects some of these latent cancers, but risks overdiagnosis.
- Overdiagnosis, estimated at 30-50% in major trials, necessitates strategies to avoid overtreatment.
Purpose of the Study:
- To evaluate the current definition of insignificant prostate cancer for active surveillance eligibility.
- To address the impact of the ISUP 2005 Gleason grading modification on active surveillance inclusion.
- To propose an updated definition balancing underestimation and inclusion for active surveillance programs.
Main Methods:
- Review of epidemiological data on prostate cancer prevalence and progression.
- Analysis of the impact of the International Society of Urological Pathology (ISUP) 2005 Gleason grading system.
- Evaluation of landmark studies defining insignificant prostate cancer for active surveillance.
Main Results:
- Current pathological definitions of insignificant prostate cancer are likely too restrictive based on epidemiological data.
- The ISUP 2005 Gleason modification may have led to increased cancer upgrading, reducing active surveillance eligibility.
- A substantial number of men with low-risk prostate cancer might be excluded from active surveillance.
Conclusions:
- The established pathological definition of insignificant prostate cancer needs re-evaluation.
- An updated definition is required to optimize the balance between detecting significant cancers and including men in active surveillance.
- Refining eligibility criteria can improve the application of active surveillance for managing low-risk prostate cancer.
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