Craig V Labbate1, Gladell P Paner2, Scott E Eggener3. 1. Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA. 2. Department of Pathology, University of Chicago Medicine, Chicago, IL, USA. 3. Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA. seggener@surgery.bsd.uchicago.edu.
Abstract
INTRODUCTION: ISUP Grade Group 1 prostate cancer is the lowest histologic grade of prostate cancer with a clinically indolent course. Removal of the term 'cancer' has been proposed and has historical precedent both in urothelial and thyroid carcinoma. METHODS: Evidence-based review identifying arguments for and against Grade Group 1 being referred to as cancer. RESULTS: Grade Group 1 has histologic evidence of tissue microinvasion and 0.3-3% rate of extraprostatic extension. Genomic evaluation suggests overlap of a minority of Grade Group 1 cancers with those of Grade Group 2. Conversely, Grade Group 1 tumors appear to have distinct genetic and genomic profiles from Grade Group 3 or higher tumors. Grade Group 1 has no documented ability for regional or distant metastasis and long-term follow up after treatment or active surveillance is safe with excellent oncologic outcomes. DISCUSSION: Grade Group 1 prostate cancer, while showing evidence of neoplasia on histology has a remarkably indolent natural history more akin to non-neoplastic precursor lesions. Consideration should be given to renaming Grade Group 1 prostate cancer, which has the potential to minimize overtreatment, treatment-related side effects, patient anxiety, and financial burden on the healthcare system.
INTRODUCTION: ISUP Grade Group 1 prostate cancer is the lowest histologic grade of prostate cancer with a clinically indolent course. Removal of the term 'cancer' has been proposed and has historical precedent both in urothelial and thyroid carcinoma. METHODS: Evidence-based review identifying arguments for and against Grade Group 1 being referred to as cancer. RESULTS: Grade Group 1 has histologic evidence of tissue microinvasion and 0.3-3% rate of extraprostatic extension. Genomic evaluation suggests overlap of a minority of Grade Group 1 cancers with those of Grade Group 2. Conversely, Grade Group 1 tumors appear to have distinct genetic and genomic profiles from Grade Group 3 or higher tumors. Grade Group 1 has no documented ability for regional or distant metastasis and long-term follow up after treatment or active surveillance is safe with excellent oncologic outcomes. DISCUSSION: Grade Group 1 prostate cancer, while showing evidence of neoplasia on histology has a remarkably indolent natural history more akin to non-neoplastic precursor lesions. Consideration should be given to renaming Grade Group 1 prostate cancer, which has the potential to minimize overtreatment, treatment-related side effects, patient anxiety, and financial burden on the healthcare system.
Authors: Yuri E Nikiforov; Raja R Seethala; Giovanni Tallini; Zubair W Baloch; Fulvio Basolo; Lester D R Thompson; Justine A Barletta; Bruce M Wenig; Abir Al Ghuzlan; Kennichi Kakudo; Thomas J Giordano; Venancio A Alves; Elham Khanafshar; Sylvia L Asa; Adel K El-Naggar; William E Gooding; Steven P Hodak; Ricardo V Lloyd; Guy Maytal; Ozgur Mete; Marina N Nikiforova; Vania Nosé; Mauro Papotti; David N Poller; Peter M Sadow; Arthur S Tischler; R Michael Tuttle; Kathryn B Wall; Virginia A LiVolsi; Gregory W Randolph; Ronald A Ghossein Journal: JAMA Oncol Date: 2016-08-01 Impact factor: 31.777
Authors: Blake B Anderson; Daniel T Oberlin; Aria A Razmaria; Bonnie Choy; Gregory P Zagaja; Arieh L Shalhav; Joshua J Meeks; Ximing J Yang; Gladell P Paner; Scott E Eggener Journal: Eur Urol Date: 2016-12-13 Impact factor: 20.096
Authors: Jeffrey J Tosoian; Mufaddal Mamawala; Jonathan I Epstein; Patricia Landis; Katarzyna J Macura; Demetrios N Simopoulos; H Ballentine Carter; Michael A Gorin Journal: Eur Urol Date: 2020-01-07 Impact factor: 20.096
Authors: Jennifer Cullen; Inger L Rosner; Timothy C Brand; Nan Zhang; Athanasios C Tsiatis; Joel Moncur; Amina Ali; Yongmei Chen; Dejan Knezevic; Tara Maddala; H Jeffrey Lawrence; Phillip G Febbo; Shiv Srivastava; Isabell A Sesterhenn; David G McLeod Journal: Eur Urol Date: 2014-11-29 Impact factor: 20.096
Authors: Scott E Eggener; R Bryan Rumble; Andrew J Armstrong; Todd M Morgan; Tony Crispino; Philip Cornford; Theodorus van der Kwast; David J Grignon; Alex J Rai; Neeraj Agarwal; Eric A Klein; Robert B Den; Himisha Beltran Journal: J Clin Oncol Date: 2019-12-12 Impact factor: 44.544
Authors: J Cuzick; D M Berney; G Fisher; D Mesher; H Møller; J E Reid; M Perry; J Park; A Younus; A Gutin; C S Foster; P Scardino; J S Lanchbury; S Stone Journal: Br J Cancer Date: 2012-02-23 Impact factor: 7.640
Authors: Martin G Sanda; Jeffrey A Cadeddu; Erin Kirkby; Ronald C Chen; Tony Crispino; Joann Fontanarosa; Stephen J Freedland; Kirsten Greene; Laurence H Klotz; Danil V Makarov; Joel B Nelson; George Rodrigues; Howard M Sandler; Mary Ellen Taplin; Jonathan R Treadwell Journal: J Urol Date: 2017-12-15 Impact factor: 7.450