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    Is favorable-risk GG2 prostate Ca suitable for active surveillance?

    FR-GG2 patients more likely to demonstrate worse pathology, higher recurrence rate

     

    Lengthy study period introduces confounders

    The study covered a long period of time (1987-2014), which can increase the number of cases and allow for longer follow-up but also introduces some confounders. A number of changes have taken place over those 27 years, including modification of biopsy techniques, grade and stage shifting, non-PSA screening tests, and imaging such as magnetic resonance. One must ask whether favorable GS 7 cancer found today, after repeated PSAs and/or MRI-guided diagnosis, is similar to the cohort used in the study and whether this type of study would be clinically more informative if a contemporary cohort was studied (eg, the last 10 years).

    Read: Immediate post-TURBT mitomycin instillation reduces recurrence risk

    Based on the adverse features noted on final pathology and the need for additional therapy after surgery, the authors caution that men with FR-GG2 may not be suited for active surveillance. It appears that the absolute difference in the need for adjuvant or late treatment is roughly 6%, and prostate cancer-specific mortality was low and was worse by only 0.5% (0.9% vs. 0.4%). Are these data compelling enough to treat 100% of patients? As clinicians, we have to contend with this reality on a regular basis.

    The management of prostate cancer always requires caution to safeguard against avoidable risks from both the treatment and the monitoring protocol. The option of active surveillance, applied judiciously, may be offered to select patients with favorable Gleason 7 (GG2) since adverse pathology or PSA recurrence seem to have minimal impact on cancer progression and mortality.

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