Outcomes of Biopsy Grade Group 1 Prostate Cancer Diagnosis in the Danish Population

Hein V Stroomberg; Signe Benzon Larsen; Torben Kjær Nielsen; J Thomas Helgstrand; Klaus Brasso; Andreas Røder

doi:10.1016/j.euo.2023.10.005

Outcomes of Biopsy Grade Group 1 Prostate Cancer Diagnosis in the Danish Population

Eur Urol Oncol. 2023 Oct 24:S2588-9311(23)00220-1. doi: 10.1016/j.euo.2023.10.005. Online ahead of print.

Authors

Hein V Stroomberg¹, Signe Benzon Larsen², Torben Kjær Nielsen³, J Thomas Helgstrand³, Klaus Brasso³, Andreas Røder³

Affiliations

¹ Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address: hein.vincent.stroomberg@regionh.dk.
² Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
³ Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

PMID: 37884421
DOI: 10.1016/j.euo.2023.10.005

Abstract

Background: Debate regarding a nomenclature change for grade group 1 (GG 1) prostate cancer to noncancer has been revived, as this could be a powerful tool in reducing the overtreatment of indolent disease.

Objective: To describe outcomes for all men diagnosed with GG 1 prostate cancer in the Danish population, with a focus on men followed conservatively.

Design, setting, and participants: This was a population-based observational study using data from the Danish Prostate Registry.

Outcome measurements and statistical analysis: We measured the cumulative incidence of curative treatment, endocrine treatment, and cause-specific mortality.

Results and limitations: The cumulative incidence of endocrine therapy at 10 yr was 5.3% (95% confidence interval [CI] 4.3-6.3%) for men with initial active surveillance and 21% (95% CI 19-23%) for men with initial watchful waiting for localized GG 1. In the GG1 cohort, the prostate cancer-specific mortality rate at 15 yr was 14% (95 CI% 11-16%) for men on watchful waiting, 10% (95 CI% 6.7-14%) for men with prostate-specific antigen <10 ng/ml on watchful waiting, and 16% (95 CI% 13-19%) for men who did not receive curative-intent treatment or histological assessment. The study is limited by the historic nature of the observations over a period during which diagnostic procedures and treatments have evolved.

Conclusions: GG 1 cancer can lead to disease-specific mortality in men with localized prostate cancer, and changing the nomenclature for all men may lead to undertreatment.

Patient summary: Key opinion leaders have suggested that prostate cancers of Gleason grade group 1 (GG 1) should be renamed as noncancer to reduce overtreatment. The argument is that low-grade cancer does not metastasize. However, our nationwide population-based study showed that death from prostate cancer can occur in some men diagnosed with GG 1 disease. These men should be considered in discussions on changing the name for GG 1 prostate cancer.

Keywords: DanProst; Gleason grade; Grade group 1; International Society of Urological Pathology; Prostate cancer.