6 DECEMBER 2024 ausdoc . com . au

Grade group 1 prostate cancer .

UCSF

Paul Smith EARLY-stage prostate cancers could be rebranded ‘ acinar neoplasm ’ in an attempt to reduce anxiety and unnecessary treatment , according to an international group of experts .

Debate has long focused on whether the term ‘ cancer ’ should be used to describe grade group 1 ( GG1 ) prostate cancer given its incidence and indolent nature .

Earlier this year , specialists from the Peter MacCallum Cancer Centre in Melbourne attended a global summit , held by the American Society of Clinical Oncology Genitourinary Cancers Symposium , to discuss the issue .

“ In autopsy series , histologic GG1 is so highly prevalent it might be considered a normal

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‘ GG1 ... might be considered a normal feature of ageing .’

feature of ageing ,” the authors said in a new paper on the meeting ’ s outcomes .

But they said it had effectively become an inadvertent diagnosis , “ incidental to the goal of identifying the clinically significant disease ”. The paper ’ s authors said

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there was no consensus on alternative names but that ‘ acinar neoplasm ’ had the broadest support , particularly among pathologists .

They stressed that GG1 should not be considered normal and “ absolutely requires ongoing active surveillance ”.

However , there were also concerns raised at the summit by pathologists about the intraprostatic heterogeneity of prostate cancer and the possibility of biopsies missing coexisting higher-grade disease .

“ Others believed this concern relates primarily to limitations in biopsy sampling and / or inter-rater variability in Gleason scoring rather than GG1 ’ s characteristics or clinical behaviour ,” the authors said , adding that the risk of undersampling had decreased in the era of high-quality pre-biopsy imaging and targeted biopsies .

Writing in the Journal of the National Cancer Institute , the authors added : “ The loss of the basal glandular cell layer — characteristic of GG1 as well as higher-grade prostate cancer — has been the sine qua non of a cancer diagnosis , along with the presence of an infiltrative growth pattern .

“ However , recent spatial transcriptomics of prostate sections confirm a continuum of genomic changes , including alterations characteristic of malignancy in histologically normal regions and , in some respects , fewer genomic changes in GG1 than in some benign regions adjacent to higher-grade cancer .”

They said , if a name change sharply reduced rates of overdiagnosis and overtreatment , the benefit-to-harm ratio could “ shift favourably to justify broader use of early baseline screening , with the chance to save many thousands of lives annually ”.