It was that doctors robotically beneficial treating all men with prostate cancer, even when their initial biopsy suggested the disease would progress slowly (or in any respect). But over the past several a long time, the treatment pendulum has swung the opposite way.
Doctors are actually more likely to recommend energetic surveillance for low- to medium-risk cancers that will never be fatal during an individual's lifetime. Active surveillance includes routine PSA checks, follow-up biopsies, and, more recently, magnetic resonance imaging of the patient's tumor. Treatment is initiated only when—or if—the disease shows signs of progression.
Recent evidence Johns Hopkins University shows that men on energetic surveillance have only a 0.1% long-term risk of death from metastasis and low-grade prostate cancer. But doctors caring for such men also face a troubling query: Which of their patients may need more aggressive cancers that require closer monitoring? New discoveries. Published in January by the Johns Hopkins team provides useful insights.
A researcher's perspective
In this case the researchers zeroed in on the diagnostic value of so-called perineural invasion, or PNI, on tumor biopsy specimens. PNI simply implies that cancer cells are migrating into the preneural space between the nerves of the prostate and surrounding tissues. Dr. Christian Pavlovic, a urologic oncologist at Johns Hopkins who led the research, says the finding of PNI raises red flags since the perineural space “provides a conduit through which tumor cells can potentially leave the prostate and can grow elsewhere in the body.”
Dr. Pavlovich's team desired to know whether PNI detected on initial or follow-up biopsies was related to a better risk of cancer progression. So they analyzed long-term follow-up data from 1,969 men enrolled in an energetic surveillance research protocol at Johns Hopkins between 1995 and 2021. ) and had undergone at the very least one follow-up biopsy since then.
What did the outcomes show?
Of the 198 men with PNI, 44% of them (all 87 men) eventually progressed to grade group 2 prostate cancer, a more advanced type of the disease with an intermediate risk of further spread. In contrast, only 26 percent of the remaining 1,771 men without PNI (461 men) had progressed to grade group 2.
Pavlovich emphasizes that despite the brand new findings, PNI “does not disqualify patients from active surveillance.” Importantly, the research showed that PNI was not related to high-risk characteristics, comparable to cancer within the lymph nodes of patients injured after surgery, or post-surgical elevations in PSA that indicate Cancer remains to be present within the body.
“What we've really shown here is that PNI puts men at risk for extraprostatic extension (cancer cells that are located just outside the confines of the prostate),” says Pavlovich. “This is not necessarily a new finding. But PNI is only found in about 10% of grade 1 patients, and this is the boldest statement ever made in the largest study ever done.” Pavlovich and colleagues concluded that PNI provides an inexpensive and available indicator to discover which men are on energetic surveillance, benefiting from more rigorous surveillance protocols including MRI and genetic tests. Will be.