We have had this discussion on the progression of G6 cancers in the past. This is futher data that Gleason grade doesn'' progress or the progression is very rare. Posted today on the New Prostate Cancer Infolink:

A new study report in Cancer Research suggests that: (a) prostate cancer aggressiveness may be established when the initial tumor is formed and not alter over time; (b) active surveillance or similar monitoring strategies really are the most appropriate initial management option for men with low-grade, low-risk cancer (potentially regardless of their age at diagnosis).

John I read it with caution earlier. We need better data before we can say how prevalent progression is because there is signs of it.

But to be clear ~ 3+3=6 is a very favorable biopsy result and may be the perfect candidate for active surveillance. Short term monitoring will help see if there is other grade components present. This is good news for someone wanting to take their time to become better educated before making a treatment decision.

Tony

Being on AS with G6 (3 out of 14), I keep reading studies such as this one about G6 being low risk and any progression is usually slow and that AS is an appropriate treatment.

However, I also would like to see these articles EMPHASIZE the fact that there is no way to ascertain that the patient is an absolute G6. This fact may have driven patients to seek active treatment(s) for fear of missing the window of opportunity, decisions that are not entirely doctors driven.

akai,
Agreed. There are cases where treatment is prudent for G6 and many patients believe that waiting is a high risk matter. This unfortunately leads to unnecessary procedures.

But the good news is that most of these long term studies on G6 low risk are proving the same things. That G3+3=6 can often be a largely indolent cancer.

Stay well...

Tony

My only concern with AS, based on a standard biopsy, would be the miniscule amount of tissue sampled . Remember, it's the mysterious world of prostate cancer after all. False negatives abound, so I'm sure higher gleason grades are just as easily missed with the blind sectional approach.

Me, I got lucky, high scoring bulls eye, even made the treatment decision for me

color doppler guided biopsies would be much more accurate to base any treatment decision on, but how available are those?

Either my hubby had a very quick progression from G6 to G8 or the biopsy totally missed the G8 tumors.  Thank goodness he decided against AS as recommended by the urologist who gave him a second opinion.  The signature below tells the story.........

 

Over the past several years, there have been announcements of new ways to detect prostate cancer and tests that could determine with good accuracy just how aggressive any discovered cancer was...Some were blood tests, some were urine tests. As far as I know, NONE of these tests have been put into widespread use..Some were expensive. Some were involved in patent fights. Some were still in development..But none of these improved diagnostic tools have been put into general use. The status quo is always difficult to change....

akai said...
Fairwind, you made my point.
I made the decision to follow AS with the full understanding of the risk that up to 35% of the G score is upgraded higher after RP.

Is that number for the "standard" 12-core biopsy only? I assume it decreases a bit if a "saturation biopsy" (40+ cores) is taken...

The biggest risk of AS is the misidentification of a higher grade on the initial biopsy, not that the tumor found will turn into a higher grade or grow so fast that the window of cure will close. We have enough data to conclude that low grade tumors either don't morph to a higher grade or metastasize, or if they do, the rate of occurrence is so rare as not to be a factor. The biggest fear of AS is that a tumor will turn into a higher grade, and this fear is unfounded based on all the evidence we have.
Where the real concern should be placed is in confirming a patient really has low grade cancer. This can be done with imaging like CDU and Mutiparametric MRIs as well as a saturation biopsy. We currently have the tools to identify those at risk for progression, we are just not using them. We have doctors that are specialized in both staging potential AS patients and monitoring them, most patients are unaware of these doctors and the active AS programs available to them.
I keep hearing arguments that we can't identify low risk from high risk patients with our current technology. This is totally untrue, we just are not using the tools currently available to us. We will never be at 100%, just as we will never eliminate all air accidents, but we can get close. 1.7% of all DXed low risk patients will die regardless of when the cancer is found or if treated or not. This is just the nature of the disease.

Tony,
Are you aware anecdotally of any cases where a low risk patient was given a saturation biopsy, CDU or a new Multiparametric MRI and then died after a low risk was confirmed? The only cases I have heard of are those variants (1.7%) in which either earlier detection or treatment would not have made a difference. These variants can also be identified by an expert pathologist.

Of the 450 patients in Klotz's 10-yr AS study, the 10-yr PCa-specific survival was 97.2%. There was only one death of a progressor whose progression was not caught within the first two years of surveillance. Klotz used only random 8 to 14 core biopsies. Our tools can always be better, but I think Klotz proved that we have adequate tools now.

Ralph,

I have assumed that the issue was not the risk of progression but the risk that a higher-grade tumor in a multi-focal mix might have been missed on previous biopsies. Thus the ongoing periodic biopsies are to a) hope to get lucky and hit the higher-grade tumor in the new random samples, and b) to monitor the situation so that when faster-growing tumors get large enough to be easy to hit one hits them. (One can't miss a fast-growing tumor forever.)

I think the point of the article and JT's posting was not that this gives 100% assurance that G6 does not progress. Rather, that this is just another indication that AS, monitored by the right medical team, may be less dangerous/more suitable for some.

Ralph, I agree with PeterDA in that I think that the main reason for follow up biopsies is not to see if the G6 progressed; rather, it's to make sure that higher G cancer was not missed previously.

Jim