Prostate cancer is the second leading cause of cancer death in men in the United States. Active surveillance offers low-risk prostate cancer patients a means to avoid the potentially harmful side effects from treatment. Pathologists help determine patient eligibility for active surveillance and today a multi-specialty team published their recommendations for making such determinations in a special on-line posting from the Archives of Pathology & Laboratory Medicine. With active surveillance, patients undergo regular visits with prostate-specific antigen (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.
Lead author Mahul Amin, MD, FCAP, is available to speak about the pathologic parameters key for the successful 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 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
Dr. Amin is chair of the Department of Pathology at Cedar-Sinai Medical Center in Los Angeles, California.
The team further concluded that the key parameters to be reported by the surgical pathologists: 1) need to be reproducible and consistently reported and 2) highlight the importance of accurate pathology reporting.
Recommendations 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 prostate cancer. PSA screening and changing consensus on PSA testing practices are among the many factors that contribute to prostate cancer’s overdiagnosis and overtreatment.
The pathology recommendations are included in the Archives article: 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 article’s authors include pathologists, radiation oncologists, surgeons, and urologists from Australia, Canada, Italy, New Zealand, Sweden, and the United States.
Role of the PathologistSometimes called the “doctor’s doctor,” pathologists are physicians who use laboratory medicine to examine cells, tissues, and body fluids to identify and diagnose disease, from pre-birth to after death. They work with other physicians on the patient care team to guide treatment for medical conditions, from diabetes to cancer.
About the College of American PathologistsAs the leading organization with more than 18,000 board-certified pathologists, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. The CAP’s Laboratory Improvement Programs, initiated 65 years ago, currently has customers in more than 100 countries, accrediting 7,600 laboratories and providing proficiency testing to 20,000 laboratories worldwide. Find more information about the CAP at cap.org. Follow CAP on Twitter: @pathologists.