Prostate cancer is the second leading cause of cancer death among men in the United States, but because such cancers are often slow growing and unlikely to metastasize, aggressive treatment regimens are typically found to be of little benefit to those diagnosed with the disease. Pathologists help to determine patient eligibility for active surveillance, a treatment option that permits low-risk prostate cancer patients to avoid the potentially harmful side effects of treatment.
In a consensus statement supported by the College of American Pathologists (CAP) and other pathology associations, an international multispecialty team has recently published its recommendations for making such eligibility determinations. The statement appears in a special online posting from the Archives of Pathology & Laboratory Medicine.1
Randomized trials and recommendations from the United States Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, have drawn attention to the overtreatment of localized, low-risk prostate cancer. Prostate-specific antigen (PSA) screening and changing consensus on PSA-testing practices are among the many factors that contribute to prostate cancer’s overdiagnosis and overtreatment.
With active surveillance, patients undergo regular physician visits with PSA tests and repeated prostate biopsies rather than aggressive treatment. The treatment option 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 of the department of pathology and laboratory medicine at Cedars-Sinai Medical Center, Los Angeles. “Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance.”
Amin spearheaded the team that highlighted the pathologic parameters considered most important for the successful identification of patients likely to succeed with active surveillance. At a general level, the key parameters 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
Highlighting the importance of accurate pathology reporting, the team further concluded that the key parameters to be reported by surgical pathologists need to be reproducible and consistently reported.
The article’s authors include pathologists, radiation oncologists, surgeons, and urologists from Australia, Canada, Italy, New Zealand, Sweden, and the United States.
A leading professional organization representing more than 18,000 board-certified pathologists, CAP serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. CAP will host its annual scientific and education meeting, CAP ’14—The Pathologists’ Meeting, September 7–10, at the Hyatt Regency, Chicago. This year’s special scientific focus is molecular medicine meets morphology. For further information, visit CAP.
1. Amin MB, Lin DW, Gore JL, et al. The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as a Management Option in Patients with Prostate Cancer: Consensus Statement with Recommendations 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. Archives of Pathology & Laboratory Medicine. 2014; early online release, August 5, 2014; doi: http://dx.doi.org/10.5858/arpa.2014-0219-SA.