Novel Definitions of Low-risk and High-risk Prostate Cancer: Implications for the European Randomized Study of Screening for Prostate Cancer Risk Assessment Tool

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Abstract

In this issue of European Urology, Roobol et al [1] present a new iteration of their previously validated European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator number 3 (RC3) using the updated 2014 In-ternational Society of Urological Pathology (ISUP) classifi-cation. By reclassifying the risk for patients on biopsy, the prediction models can be potentially improved to detect negative, low-risk, and high-risk prostate cancer (PCa). The challenges of overdiagnosis and overtreatment are well documented and have prompted patients and clinicians to re-examine the decision on cancer screening [2]. In the past, patients willingly sought investigations and underwent treatments for overall survival benefits that, in hindsight, were imbued with uncertainty. Yet there are countless men who continue to substantially gain from early diagnosis and treatment of high-risk PCa. This has been the impetus for a risk-adapted, individualized approach to localized prostate cancer treatment decisions. The aim of this investigation was to augment the RC3 in its prediction of biopsy-detectable low-risk (LR) or high-risk (HR) PCa. The authors conducted a full re-evaluation of the 3616 available specimens of all men (aged 54–74[ 1 _ T D $ D I F F ]) biopsied in the first round (November 1993–March 2000) of the Rotterdam ERSPC section. Risk by Gleason score (GS) 3 + 4 (ISUP grade 2) was further substratified on the basis of tumor-specific information, namely the presence or ab-sence of either an invasive cribriform growth pattern (CR + [ 6 _ T D $ D I F F ]) and/or intraductal carcinoma (IDC +). This novel approach is rooted in the observation that CR/IDC-negative ISUP grade 2 has similar survival to ISUP grade 1 (GS 3 + 3). The 885 cancers detected were stratified into three main risk groups: no cancer, LR (ISUP grade 1, ISUP grade 2 CR/IDC À) PCa, and HR (ISUP grade 2 CR/IDC + , ! ISUP grade 3) PCa. Reclassification was common: 9% of GS 3 + 3 was graded HR, 42% of GS 3 + 4 was graded LR, and 14% of GS > 3 + 4 was graded LR; there was no change in diagnosis for the 2731 negative biopsies. The predictive accuracy of the risk calculator was tested for detection of LR PCa, HR PCa, and the absence of PCa using two models. The first model included prostate-specific antigen (PSA), digital rectal examine (DRE) outcome, transrectal ultrasound (TRUS) outcome, and TRUS-assessed prostate volume. The second model removed the TRUS-related variables and included DRE-assessed prostate volumes (based on TRUS measurements: 25 cm 3 [ 2 _ T D $ D I F F ] , 40 cm 3

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Pruthi, D. K., Ankerst, D. P., & Liss, M. A. (2017, July 1). Novel Definitions of Low-risk and High-risk Prostate Cancer: Implications for the European Randomized Study of Screening for Prostate Cancer Risk Assessment Tool. European Urology. Elsevier B.V. https://doi.org/10.1016/j.eururo.2017.02.009

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