Pathologists Publish Recommendations for Prostate Cancer Active Surveillance

Pathologists have developed a set of recommendations to help effectively diagnose low-risk prostate cancer (PrCa) patients eligible for active surveillance and less harmful treatment options.

Active surveillance offers low-risk PrCa patients a means to avoid the potentially harmful side-effects from treatment. Analyses from the United States Preventive Services Task Force (an independent group of national experts in prevention and evidence-based medicine) and randomized trials have drawn attention to overtreatment of localized, low-risk PrCa. Prostate-specific antigen (PSA) screening and changing consensus on PSA testing practices are among the many factors that contribute to PrCa’s overdiagnosis and overtreatment. Now a multispecialty team of pathologists has published its recommendations for patient eligibility, with professional organization endorsements, including from the College of American Pathologists (CAP; Northfield, IL, USA).

With active surveillance, patients undergo regular visits with PSA tests and repeated prostate biopsies rather than aggressive treatment. It 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,” said first author Mahul Amin, MD, FCAP, and chair of Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center (Los Angeles, CA, USA), “Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates.”

Dr. Amin spearheaded the team that highlighted the pathologic parameters key for identification of patients likely to succeed with active surveillance. The key parameters, at a general level, address: Sampling, submission, and processing issues in needle biopsies used to diagnose PrCa; Tumor extent in needle biopsies; Biopsy reporting for all and special cases; Gleason scores, the system for grading PrCa tissue based on how it looks under a microscope; Precision medicine markers; Other pathologic considerations. The team further concluded that the key parameters to be reported by the surgical pathologists need to be reproducible and consistently reported, and highlight the importance of accurate pathology reporting.

As physicians who use laboratory medicine to examine cells, tissues, and body fluids to identify and diagnose disease, from pre-birth to after death, pathologists work with other physicians on the patient care team. The article with the new recommendations is titled: 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. The authors include pathologists, radiation oncologists, surgeons, and urologists from Australia, Canada, Italy, New Zealand, Sweden, and the United States. The article was published August 5, 2014, as a special early online posting from the journal Archives of Pathology & Laboratory Medicine.

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College of American Pathologists