International Society of Urological Pathology grade group 1 (GG 1) prostate cancer (PCa) is generally considered insignificant, with recent suggestions that it should even be considered as "noncancerous". We evaluated outcomes for patients with GG 1 PCa on biopsy (bGG 1) and high-risk features (prostate-specific antigen [PSA] >20 ng/ml and/or cT3-4 stage) to challenge the hypothesis that every case of bGG 1 PCa has a benign disease course. We used the multi-institutional EMPaCT database, which includes data for 9508 patients with high-risk PCa undergoing surgery. We included patients with bGG 1 PCa (n = 848) in our analysis and divided them into three groups according to PSA >20 ng/ml, cT3-4 stage, or both. The estimated 10-yr cancer-specific survival (CSS) rate was 96% in the overall population, 88% in the group with both PSA >20 ng/ml and cT3-4 stage, 97% in the group with PSA >20 ng/ml alone, and 98% in the group with cT3-4 stage alone. Similar CSS outcomes were found in subgroups with GG 1 PCa on pathology (n = 502) and with GG 1 on biopsy diagnosed after 2005 (n = 253). Study limitations include the lack of magnetic resonance imaging (MRI) staging and MRI-targeted biopsies. In conclusion, patients with GG 1 and either PSA >20 ng/ml or cT3-4 stage have a low risk of dying from their cancer after surgery. However, patients with GG 1 PCa and both PSA >20 ng/ml and cT3-4 stage are at higher risk of cancer-specific mortality and active treatment should be discussed for this subgroup.
We assessed outcomes for patients diagnosed with low-grade prostate cancer on biopsy who also had one or two factors associated with high risk disease. Men with both of those risk factors had a higher risk of dying from their prostate cancer. Active treatment should be discussed for this subgroup of patients.
European urology open science. 2024 Jun 26*** epublish ***
Daimantas Milonas, Alexander Giesen, Tim Muilwijk, Charlotte Soenens, Gaëtan Devos, Zilvinas Venclovas, Alberto Briganti, Paolo Gontero, R Jeffrey Karnes, Piotr Chlosta, Frank Claessens, Gert De Meerleer, Wouter Everaerts, Markus Graefen, Giansilvio Marchioro, Rafael Sanchez-Salas, Bertrand Tombal, Henk Van Der Poel, Hendrik Van Poppel, Martin Spahn, Steven Joniau, European Multicenter Prostate Cancer Clinical and Translational (EMPaCT) Research Group
Department of Urology, University Hospitals Leuven, Leuven, Belgium., Department of Urology, Lithuanian University of Health Sciences, Kaunas, Lithuania., Department of Urology, University Vita Salute, San Raffaele Hospital, Milan, Italy., Department of Urology, University of Turin, A.O.U. San Giovanni Battista-le Molinette, Turin, Italy., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, Jagiellonian University Medical College, Krakow, Poland., Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium., Martini Klinik am UKE GmbH, Hamburg, Germany., Department of Urology, University of Piemonte Orientale, Novara, Italy., Department of Surgery, Division of Urology, McGill University, Montreal, Canada., Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Lindenhofspital Bern, Bern, Switzerland.