College of American Pathologists Publishes Recommendations for Prostate Cancer Active Surveillance
Prostate cancer is the second leading cause of cancer death in men in the United States. Active surveillance offers low-risk prostate cancer patients a means to avoid the potentially harmful side effects from treatment. In a recent article in the Archives of Pathology & Laboratory Medicine, a multispecialty team of pathologists, radiation oncologists, surgeons, and urologists published a consensus statement with recommendations for determining patient eligibility for active surveillance.
The recommendations were supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation.
With active surveillance, patients undergo regular visits with prostate-specific antigen (PSA) tests and repeated prostate biopsies rather than aggressive treatment. It is distinguished from watchful waiting, in which treatment for localized disease is withheld and palliative treatment for systemic disease is initiated.
“Active surveillance is an important management option for men with low-risk prostate cancer,” says lead author Mahul Amin, MD, FCAP, Chair, Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles. “Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance.”
Key Pathologic Parameters
Dr. Amin spearheaded the team that highlighted the pathologic parameters key for the successful identification of patients likely to succeed with active surveillance. The key parameters, at a general level, address:
- Sampling, submission, and processing issues in needle biopsies used to diagnose prostate cancer
- Tumor extent in needle biopsies
- Biopsy reporting for all and special cases
- Gleason scores, the system for grading prostate cancer tissue based on how it looks under a microscope
- Precision medicine markers
- Other pathologic considerations
The team further concluded that the key parameters to be reported by surgical pathologists (1) need to be reproducible and consistently reported and (2) highlight the importance of accurate pathology reporting.
Recommendations from the U.S. Preventive Services Task Force and randomized trials have drawn attention to overtreatment of localized, low-risk prostate cancer. PSA screening and changing consensus on PSA testing practices are among the many factors that contribute to prostate cancer’s overdiagnosis and overtreatment.
Dr. Amin is the corresponding author for the Archives of Pathology & Laboratory Medicine article.
Dan Berney, MD, receives a yearly grant from Myriad Genetics to test the effectiveness of Prolaris. The other study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
