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• W4237512519 abstract "In the current climate of PSA screening controversy, focusing on preventing overtreatment in “Turtles” while maintaining the potentially lifesaving treatment window in “Rabbits” is essential. 1 Lange P.H. Future studies in localized prostate cancer. What should we think? What can we do?. J Urol. 1994; 152: 1932-1938 Abstract Full Text PDF PubMed Google Scholar As a result, we aimed to identify clinical parameters that predict significant occult aggressive disease in patients who appear to be “Turtles.” To do so, we utilized a large contemporary cohort from the SEER database, with the recent addition of prostate needle biopsies to establish risk factors for significant or “extreme” upgrading at radical prostatectomy. We defined “extreme” upgrading as the International Society of Urological Pathology (ISUP) Gleason group change of ≥2, in anticipation of the adoption of the ISUP grading guidelines into clinical practice. We agree with the editorial comments that the migration to ISUP Gleason scoring groups (1-5) may reduce overtreatment of prostate cancer compared with the current system by reducing the number assigned to each grade (thereby making it appear less aggressive) and improve patient counseling. However, it remains to be seen whether this system has any impact on the accuracy of grading biopsies. Because a large part of grading inaccuracy can be attributed to sampling, 2 Bjurlin M.A. Carter H.B. Schellhammer P. et al. Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol. 2013; 189: 2039-2046 Abstract Full Text Full Text PDF PubMed Scopus (155) Google Scholar the ISUP grading guidelines may not dramatically improve grading or variable concordance rates 3 Schreiber D. Wong A.T. Rineer J. Weedon J. Schwartz D. Prostate biopsy concordance in a large population-based sample: a surveillance, epidemiology and end results study. J Clin Pathol. 2015; 68: 453-457 Crossref PubMed Scopus (25) Google Scholar on their own. Consequently, identifying clinical parameters that may indicate undergrading on prostate needle biopsy will continue to be clinically relevant. New technologies such as magnetic resonance imaging/magnetic resonance-fusion biopsy, withimproved tumor sampling and detection of high-grade disease, may improve patient risk stratification moving forward. 4 Schoots I.G. Petrides N. Giganti F. et al. Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol. 2015; 67: 627-636 Abstract Full Text Full Text PDF PubMed Scopus (251) Google Scholar , 5 Mariotti G.C. Costa D.N. Pedrosa I. et al. Magnetic resonance/transrectal ultrasound fusion biopsy of the prostate compared to systematic 12-core biopsy for the diagnosis and characterization of prostate cancer: multi-institutional retrospective analysis of 389 patients. Urol Oncol. 2016; https://doi.org/10.1016/j.urolonc.2016.04.008 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar However, although gaining traction, the use of magnetic resonance or magnetic resonance-fusion biopsy is not widely used in community practice (at least in our region). As a result, this study as well as others using SEER data (where a recent audit described “PSA error rates were significantly lower than predicted,” http://seer.cancer.gov/data/psa-values.html), despite their limitations, are reflective of current practice and serve as a reminder of the challenge at hand and a call to action to accurately identify “Rabbits” at the time of diagnosis, before they have a chance to escape." @default.
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• W4237512519 date "2016-10-01" @default.
• W4237512519 modified "2023-09-30" @default.
• W4237512519 title "Author Reply" @default.
• W4237512519 doi "https://doi.org/10.1016/j.urology.2016.04.060" @default.
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