Volume Re-classification Portends Grade Re-classification in Gleason 6 Prostate Cancer

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Prostate cancer patients on active surveillance who experienced volume re-classification at substantially higher risk of developing grade re-classification.
Prostate cancer patients on active surveillance who experienced volume re-classification at substantially higher risk of developing grade re-classification.

Patients with prostate cancer on active surveillance who experienced volume re-classification were at a substantially higher risk of developing grade re-classification, according to an article published online ahead of print in The Journal of Urology.1

In this study, researchers evaluated the relative risk of grade re-classification and outcomes of 555 patients who developed high-volume Gleason 6 prostate cancer while under active surveillance.

With a median follow-up of 46 months, 70 patients demonstrated an increase in tumor volume at or after their second biopsy (B2).

Prostate-specific antigen at diagnosis did not differ (P=0.095) between those who never experienced volume or grade re-classification, however median prostate volume was smaller in patients who demonstrated volume re-classsification (P<0.001).

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Occurrence of pure volume re-classification was 6.8%, 6.1%, and 7.8% at B2, B3, and B4, respectively. Those with volume re-classification more frequently experienced later grade-reclassification compared with those without (33.3% vs 9.3%).

The authors concluded that urologists should monitor tumor core involvement and adjust it accordingly for early volume re-classification in younger men in good health.

Reference

  1. Komisarenko M, Wong, L-M, Richard PO, et al. An increase in Gleason 6 tumour volume while on active surveillance portends a greater risk of grade reclassification with further follow-up. [published online ahead of print September 25, 2015]. J Urol. doi: 10.1016/j.juro.2015.09.081.

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