RE: Active Surveillance Conference

[Guest guest]

I think Dr. Meyers attended the conference and was reacting to what he observed

in the presentations, not the draft consensus report. As he stated in the

video, increased evidence indicates that a true Gleason 3+3 tumor-- i.e. no

pattern 4 or 5-- is truly indolent; slow growing and not a risk to life.

In contrast, the presence of any pattern 4 or 5 tissue presents a greater risk

of an aggressive cancer. This has resulted in recommendations to move any

pattern 4 or 5 observed in the pathology to be included in the Gleason sum. So,

if the two dominate patterns are 3, but there is any 4, the sum would be 7. If

the two dominate paterns were 3 but there was any 5, the sum would be 8.

Terry is correct that this would result in additional 'Gleason Migration'

compared to the past Gleason sums. However, it appears to me to be a positive

move in trying to better sort out the prostate cancer 'lambs' from the 'lions'.

The bottom line (pun intended) is that we need better diagnostics to support

intelligent and minimal damage treatments for prostate cancer.

The Best to You and Yours!

Jon in Nevada

>

> Whilst the recently concluded conference on Active Surveillance is a very

> important one I believe that Dr Myers may have jumped the gun somewhat in

> his video a link to which is being posted, and focussed on an issue that may

> be somewhat misleading if his remarks are based on the draft report from the

> conference.

> You can read the DRAFT REPORT here

> http://consensus.nih.gov/2011/docs/prostate/Prostate%20Cancer%20Draft%20Stat

> ement%2012.07.11.am.pdf for yourselves and see if you come to a different

> conclusion to that presented by Dr Myers. It seems that the relevant section

> of the report upon which Dr Myers' statement is based is on page 14, line 7

> <snip> The 30-day mortality of radical prostatectomy is one-half percent.

> <snip> This presumably refers to the risks associated with any major

> surgery.

> On the other hand in line 4 on the same page the statment is made

>

> <snip> There is weak evidence from cohort studies that observational

> strategies result in an increase in death rates relative to both radiation

> therapy and radical prostatectomy. <snip>

> What is undoubtedly likely to be an unintended consequence of this meetings

> is that the number of men diagnosed with Gleason Scores of 3+3=6 will

> decline and the number diagnosed with GS 7a (3+4) and 7b (4+3) will

> increase. We have already seen this, dubbed the Gleason Migration, after the

> decision was made to no longer define Gleason Grade 2 material as 'cancer'.

> This meant that GS 5 diagnoses disappeared, but GS 6 diagnoses increased.

> It seems likely now that pathologists may proceed with the proposal to use a

> third focus. This will mean that if there is any material graded as 5 in a

> sample, this will lead to a Gleason Score of 8 or 9. A scary proposition.

> All the best

> Prostate men need enlightening, not frightening

> Terry Herbert - diagnosed in 1996 and still going strong