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Tumor Progression02:07

Tumor Progression

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Tumor progression is a phenomenon where the pre-formed tumor acquires successive mutations to become clinically more aggressive and malignant. In the 1950s, Foulds first described the stepwise progression of cancer cells through successive stages.
Colon cancer is one of the best-documented examples of tumor progression. Early mutation in the APC gene in colon cells causes a small growth on the colon wall called a polyp. With time, this polyp grows into a benign, pre-cancerous tumor. Further...
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Updated: Jun 13, 2025

Author Spotlight: Advancing Prostate Cancer Research Through Improved Tissue Sampling and Biobanking
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Quantification of Gleason Pattern 4 Metrics Identifies Pathologic Progression in Patients With Grade Group 2 Prostate

Marlon Perera1, Melissa Assel2, Sunny Nalavenkata1

  • 1Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY.

Clinical Genitourinary Cancer
|September 11, 2024
PubMed
Summary

Active surveillance for Grade Group 2 prostate cancer may need new progression criteria. Focusing solely on Grade Group 3 (GG3) may miss increases in Grade Group 4 (GP4) quantity, suggesting GP4 length is a better measure.

Keywords:
BiomarkerISUP gradingOutcomesProstate biopsyRisk stratfication

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Area of Science:

  • Urology
  • Oncology
  • Pathology

Background:

  • Active surveillance (AS) is used for Grade Group (GG) 2 prostate cancer.
  • Progression to GG3 on biopsy triggers intervention.
  • Current criteria may be obscured by indolent disease changes.

Purpose of the Study:

  • To explore changes in Grade Group 4 (GP4) quantity during AS.
  • To propose alternative progression definitions based on GP4 changes.

Main Methods:

  • Assessed patients on AS with GG2 disease on diagnostic biopsy.
  • Evaluated subsequent surveillance biopsy approximately 1 year later.
  • Measured changes in overall %GP4 and total length GP4 (mm).

Main Results:

  • Median change in GP4 length was -0.12 mm and %GP4 was -2.5% in 61 patients.
  • Excluding patients with no GP4, median change was 0.19 mm and 1.2% increase.
  • Three patients progressed to GG3; 2 others had significant GP4 length increases without meeting GG3 criteria.

Conclusions:

  • GG3 presence alone is a questionable trigger for treatment in AS.
  • Suggests incorporating GP4 length increase as a progression measure.
  • Alternative definitions for progression may improve AS management.