Missed aggressive cases rise slightly
CANCER DIGEST – April 23, 2022 – The incidence of the lowest-risk prostate cancer was cut in half following implementation of new guidelines in 2018, according to a new analysis of cancer data.
The results published in the March 28, 2022 Journal of the National Cancer Institute, showed that only 10 percent of radical prostatectomy specimens were found to be low-grade cancers, showing that urologists have moved away from surgery to remove the prostate to active surveillance, or close monitoring of suspected prostate cancers.
“It is encouraging to see that urologists in the United States have moved away from over-utilization of radical therapies for the management of low-risk prostate cancer,” first author Dr. Leonardo Borregales said in a press release.
The study led by Dr. Jim Hu and Borregales of Weill Cornell Medicine analyzed 438,000 men with newly diagnosed prostate cancer from a national database between 2010 and 2018. They analyzed trends in incidence of prostate cancer using several measures of risk including Gleason Grade, biopsy after radical prostatectomy and PSA. In addition the researchers took into account rates of obesity and the addition of pre-biopsy MRI.
They found that the incidence of the lowest risk prostate cancer (Gleason Grade 1) fell from 52 cases per 100,000 men to 26 cases per 100,000. In addition the proportion of men whose pathology specimen was graded Gleason Grade 1 following radical prostatectomy dropped from 32 percent to 10 percent.
One negative finding, however, was that the number of prostate cancers that had spread beyond the prostate at diagnosis had increased from 3 percent to 5.2 percent over the study period.
The US Preventative Services Task Force recommended against screening all men for prostate cancer using the PSA levels in 2012. The guidelines-setting group amended that in 2018 recommending shared decision-making based on PSA for men age 55 to 69 years along with continued monitoring after detection of low-risk cancer.
The authors concluded that health authorities should consider risk-stratified screening, including MRI and use of biomarkers to continue minimizing over diagnosis and avoid biopsy in men with low-risk prostate cancer.
Source: Weill Cornell Medicine press release
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