A recent study has unveiled that some men diagnosed with “Grade Group one” (GG1) prostate cancer may face higher risks than initially suggested by biopsy results. This research, spearheaded by Weill Cornell Medicine, University Hospitals Cleveland, and Case Western University, highlights a significant gap in the current diagnostic approach.
The study, published on July 31 in the journal JAMA Oncology, underscores the limitations of relying solely on biopsy grades. Biopsies, which examine only small sections of the prostate, can overlook more aggressive cancer cells, potentially leading to underestimation of disease risk. According to the research, one in six men with GG1 cancer may actually have intermediate- or high-risk cancer when additional clinical features are considered.
Reevaluating the Cancer Label
The findings could influence ongoing discussions about whether to remove the cancer label from GG1 tumors. Dr. Jonathan Shoag, a co-senior author of the study and an associate professor of urology at Case Western Reserve University, emphasized the distinction between “low grade” and “low risk.” He noted, “Attempts to rename GG1 are misguided as many patients with GG1 cancers on biopsy have substantial risks of their cancers causing pain and suffering over their lifetime if untreated.”
The study utilized data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, covering approximately 300,000 men diagnosed with localized prostate cancer between 2010 and 2020. Among these, about 117,000 men were categorized as GG1 based on biopsy results. Traditionally, GG1 is associated with a low risk of progression, often managed through active surveillance involving regular PSA tests, biopsies, and MRI scans.
Uncovering Hidden Risks
Dr. Bashir Al Hussein, co-senior author and assistant professor of urology at Weill Cornell Medicine, noted the potential for misclassification. “Our data show that up to 30% of patients who were diagnosed with GG1 but were in the higher risk category underwent active surveillance, which means they were potentially undertreated,” Al Hussein explained.
“We don’t want to miss aggressive cancers that initially present as Grade Group One on biopsy,” said Dr. Bashir Al Hussein. “Such underestimation of risk could lead to undertreatment and poor outcomes.”
By analyzing additional clinical data such as PSA levels and tumor sizes, the researchers identified over 18,000 men with higher-risk cancers that might require more aggressive treatments like radiation therapy or radical prostatectomy.
Implications for Patient Care
Understanding the correlation between cancer classification and clinical outcomes is crucial, especially as some physicians advocate for removing the “cancer” label from GG1 prostate cancer to reduce patient anxiety and avoid unnecessary treatment. However, the study cautions against a uniform approach.
“There has been an unfortunate conflation of several different terms by some of my colleagues who are trying to rename GG1 cancer,” explained Dr. Jonathan Shoag. “One is that biopsy GG1 and prostatectomy GG1 are similar, but they are not. As clinicians, we must make decisions based on each patient and his biopsy results in that context.”
Dr. Neal Arvind Patel, the study’s first author and assistant professor of clinical urology, highlighted the need for a deeper understanding of the biology of low-grade tumors with adverse clinical features. This could lead to improved prognostic tools and patient outcomes.
Future Directions and Patient Education
Dr. Al Hussein emphasized the importance of improving patient education regarding GG1 prostate cancer. “We need to find a better way to inform patients about their prognosis when they have GG1 prostate cancer with adverse clinical features,” he stated. “As physicians, the responsibility falls on us to educate patients and provide them with the information they need to understand their diagnosis and decide on the best approach for treatment, while continuing to advocate for active surveillance for those who are indeed low risk.”
This research, supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust, could pave the way for more personalized treatment strategies and better patient outcomes in prostate cancer care.
