A recent study suggests that a notable proportion of men diagnosed with grade group 1 (GG1) prostate cancer may actually harbor higher-risk disease than initially indicated by biopsy results. The findings were published online July 31 in JAMA Oncology.
Researchers led by Neal A. Patel, M.D., of Weill Cornell Medicine in New York City, conducted a population-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) program. The study analyzed cancer-specific outcomes in 117,162 men with localized GG1 prostate cancer, stratified according to National Comprehensive Cancer Network (NCCN) risk categories.
Among the study participants, 9 percent had favorable intermediate-risk disease, 3 percent had unfavorable intermediate-risk disease, and 4 percent were classified as high-risk. Alarmingly, 60 percent of men with high-risk GG1 disease were found to have adverse pathology following prostatectomy.
Prostate cancer-specific mortality rates for men with unfavorable intermediate-risk GG1 and high-risk GG1 disease were 2.4 percent and 4.7 percent, respectively. These rates were comparable to those observed in men with favorable intermediate-risk GG2 and unfavorable intermediate-risk GG2 disease, which were 2.1 percent and 4.0 percent, respectively.
When compared with low-risk GG1 disease, the risk of prostate cancer-specific mortality increased significantly in higher-risk groups, with adjusted hazard ratios of 1.60 for favorable intermediate-risk GG1, 2.10 for unfavorable intermediate-risk GG1, and 3.58 for high-risk GG1.
Co-senior author Bashir Al Hussein of Weill Cornell Medicine emphasized the clinical implications, stating, “We need a better way to inform patients about their prognosis when GG1 prostate cancer presents with adverse clinical features. Physicians have a responsibility to educate patients, helping them understand their diagnosis and make informed treatment decisions, while continuing to advocate for active surveillance in those who are truly low risk.”
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