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Speaker 1: Going to give us one more analogy…

Jeff Simko: Yeah, I just wanted to give... I'm probably a little bit out of place and I'm sorry, I kind of just jumped in here. But I wanted to give some examples of some other tumor types and issues that come up in other organ systems that bring up similar issues. So this actually is a breast cancer called tubular carcinoma. And I think to the people here, urologists, this actually looks like 3+3 cancer. The left diagram there looks like 3+3 prostate cancer, but that's actually a tubular breast cancer. And on the right is just showing a tubular breast cancer, with the myoepithelial marker proving that that's actually an infiltrating cancer.

So this is an example of an invasive cancer, and here's the outcome for that cancer. If you look at these types of cancer, the right is survival, and you see the survival is 100% even though this is an infiltrating cancer. So just some of these arguments relate to something being invasive without causing poor outcomes.

And then I think another example that people bring up for what we're dealing with is that you see molecular changes in prostate cancer that suggest you should be calling it cancer. But if you look at the progression of lesions in the colorectum, you see these mutations over time as this thing progresses to cancer. And just showing on the left is benign colon, and moving to the right you can see invasion. Along the way here, it looks a lot like 3+3 cancer. But as you get to more complicated growth like the middle picture there, where you're getting a certain number of mutations and so forth, and you get these complex growths, this is starting to look more like a pattern 4 or actually a cancer that actually causes problems.

So when you're on the single gland side of that, it seems like outcomes are good, but when you get these complex growths, that's when you really have what might be a real malignant transformation and poor outcomes. So maybe that's where you should, as Matt showed in his first slide, push this line farther down and not base it on infiltration, but on other biologic factors that we might need to look at.