A recent study published in European Urology Oncology has revealed critical insights into the prognosis of patients with Grade Group 1 (GGG 1) prostate cancer. The research highlights that individuals exhibiting either >50% positive biopsies (PPB) or a prostate-specific antigen (PSA) level >20 ng/ml are at an increased risk of adverse pathology, early PSA recurrence, and mortality.
The study examined clinical factors associated with undetected high-risk prostate cancer, prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM) following radical prostatectomy (RP) in patients diagnosed with biopsy-proven GGG-1 adenocarcinoma of the prostate. Conducted at University Hospital Hamburg-Eppendorf, the primary cohort consisted of 10,228 patients selected between February 28, 1992, and September 7, 2023. Among these, 9,248 patients underwent a 12-core TRUS-guided systematic biopsy (SBx), with a median age of 63 years.
Findings indicate that patients diagnosed with GGG 1 prostate cancer using modern targeted biopsies (CBx) who have over 50% positive biopsies or a PSA level exceeding 20 ng/ml are significantly more likely to experience adverse pathology during RP and early PSA recurrence. Furthermore, these patients, particularly those who underwent SBx, showed an increased risk of PCSM and ACM.
The study underscores the importance of considering clinical factors during diagnosis to identify patients at higher risk for undetected higher-grade and advanced-stage cancers. Patients with GGG-1 prostate cancer who meet the risk criteria of more than 50% positive biopsies or a PSA level over 20 ng/ml are advised to strongly consider a systematic rebiopsy. Early intervention with RP is linked to lower prostate cancer-related mortality rates, while delays in diagnosis and treatment can significantly affect patient outcomes.
The systematic biopsy (SBx) group provided an optimal evaluation of long-term mortality risk, as the targeted biopsy (CBx) technique has been in routine use for only five years. Consequently, the study suggests that CBx may overestimate PCSM and ACM compared to actual risks, as evidenced by a 2.47% lower incidence of adverse pathology at RP in the CBx group compared to the SBx group.
Prostate cancer remains the most frequently diagnosed cancer among men worldwide and the fifth leading cause of cancer-related deaths in male population. In 2020, there were 1,414,249 new cases globally, resulting in 375,000 deaths. Prostate cancer was the most frequently diagnosed malignancy in over half of the world’s countries.
The study highlights the increased risks faced by patients classified as GGG 1 with either more than 50% positive biopsies or a PSA level >20 ng/ml, aiding clinicians in identifying those at higher risk for aggressive prostate cancer or elevated mortality rates.
Reference
- Tilki D, Chen MH, Huland H, Graefen M, D’Amico AV. Mortality Risk for Patients with Biopsy Gleason Grade Group 1 Prostate Cancer. European Urology Oncology. 2024 Jul; S2588931124001561.
- Wang L, Lu B, He M, Wang Y, Wang Z, Du L. Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019. Front Public Health. 2022 Feb 16;10:811044.