Gleason 6 prostate cancer

Translating biology into population health

Scott E. Eggener, Ketan Badani, Daniel A. Barocas, Glen W. Barrisford, Jed Sian Cheng, Arnold I. Chin, Anthony Corcoran, Jonathan I. Epstein, Arvin K. George, Gopal N. Gupta, Matthew H. Hayn, Eric C. Kauffman, Brian Lane, Michael A. Liss, Moben Mirza, Todd M. Morgan, Kelvin Moses, Kenneth G. Nepple, Mark A. Preston, Soroush Rais-Bahrami & 13 others Matthew J. Resnick, M. Minhaj Siddiqui, Jonathan Silberstein, Eric A. Singer, Geoffrey A. Sonn, Preston Sprenkle, Kelly L. Stratton, Jennifer Taylor, Jeffrey Tomaszewski, Matt Tollefson, Andrew Vickers, Wesley White, William T. Lowrance

Research output: Contribution to journalReview article

52 Citations (Scopus)

Abstract

Purpose Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management. Materials and Methods Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes. Results The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes. Conclusions The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.

Original languageEnglish (US)
Pages (from-to)626-634
Number of pages9
JournalJournal of Urology
Volume194
Issue number3
DOIs
StatePublished - Sep 1 2015

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Prostatic Neoplasms
Health
Prostate-Specific Antigen
Population
Neoplasms
Life Expectancy
Physicians' Practice Patterns
Natural History
Early Detection of Cancer
Molecular Biology
Consensus
Decision Making
Therapeutics
Biomarkers
History
Morbidity

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Eggener, S. E., Badani, K., Barocas, D. A., Barrisford, G. W., Cheng, J. S., Chin, A. I., ... Lowrance, W. T. (2015). Gleason 6 prostate cancer: Translating biology into population health. Journal of Urology, 194(3), 626-634. https://doi.org/10.1016/j.juro.2015.01.126

Gleason 6 prostate cancer : Translating biology into population health. / Eggener, Scott E.; Badani, Ketan; Barocas, Daniel A.; Barrisford, Glen W.; Cheng, Jed Sian; Chin, Arnold I.; Corcoran, Anthony; Epstein, Jonathan I.; George, Arvin K.; Gupta, Gopal N.; Hayn, Matthew H.; Kauffman, Eric C.; Lane, Brian; Liss, Michael A.; Mirza, Moben; Morgan, Todd M.; Moses, Kelvin; Nepple, Kenneth G.; Preston, Mark A.; Rais-Bahrami, Soroush; Resnick, Matthew J.; Siddiqui, M. Minhaj; Silberstein, Jonathan; Singer, Eric A.; Sonn, Geoffrey A.; Sprenkle, Preston; Stratton, Kelly L.; Taylor, Jennifer; Tomaszewski, Jeffrey; Tollefson, Matt; Vickers, Andrew; White, Wesley; Lowrance, William T.

In: Journal of Urology, Vol. 194, No. 3, 01.09.2015, p. 626-634.

Research output: Contribution to journalReview article

Eggener, SE, Badani, K, Barocas, DA, Barrisford, GW, Cheng, JS, Chin, AI, Corcoran, A, Epstein, JI, George, AK, Gupta, GN, Hayn, MH, Kauffman, EC, Lane, B, Liss, MA, Mirza, M, Morgan, TM, Moses, K, Nepple, KG, Preston, MA, Rais-Bahrami, S, Resnick, MJ, Siddiqui, MM, Silberstein, J, Singer, EA, Sonn, GA, Sprenkle, P, Stratton, KL, Taylor, J, Tomaszewski, J, Tollefson, M, Vickers, A, White, W & Lowrance, WT 2015, 'Gleason 6 prostate cancer: Translating biology into population health', Journal of Urology, vol. 194, no. 3, pp. 626-634. https://doi.org/10.1016/j.juro.2015.01.126
Eggener SE, Badani K, Barocas DA, Barrisford GW, Cheng JS, Chin AI et al. Gleason 6 prostate cancer: Translating biology into population health. Journal of Urology. 2015 Sep 1;194(3):626-634. https://doi.org/10.1016/j.juro.2015.01.126
Eggener, Scott E. ; Badani, Ketan ; Barocas, Daniel A. ; Barrisford, Glen W. ; Cheng, Jed Sian ; Chin, Arnold I. ; Corcoran, Anthony ; Epstein, Jonathan I. ; George, Arvin K. ; Gupta, Gopal N. ; Hayn, Matthew H. ; Kauffman, Eric C. ; Lane, Brian ; Liss, Michael A. ; Mirza, Moben ; Morgan, Todd M. ; Moses, Kelvin ; Nepple, Kenneth G. ; Preston, Mark A. ; Rais-Bahrami, Soroush ; Resnick, Matthew J. ; Siddiqui, M. Minhaj ; Silberstein, Jonathan ; Singer, Eric A. ; Sonn, Geoffrey A. ; Sprenkle, Preston ; Stratton, Kelly L. ; Taylor, Jennifer ; Tomaszewski, Jeffrey ; Tollefson, Matt ; Vickers, Andrew ; White, Wesley ; Lowrance, William T. / Gleason 6 prostate cancer : Translating biology into population health. In: Journal of Urology. 2015 ; Vol. 194, No. 3. pp. 626-634.
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title = "Gleason 6 prostate cancer: Translating biology into population health",
abstract = "Purpose Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management. Materials and Methods Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes. Results The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90{\%} of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes. Conclusions The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.",
author = "Eggener, {Scott E.} and Ketan Badani and Barocas, {Daniel A.} and Barrisford, {Glen W.} and Cheng, {Jed Sian} and Chin, {Arnold I.} and Anthony Corcoran and Epstein, {Jonathan I.} and George, {Arvin K.} and Gupta, {Gopal N.} and Hayn, {Matthew H.} and Kauffman, {Eric C.} and Brian Lane and Liss, {Michael A.} and Moben Mirza and Morgan, {Todd M.} and Kelvin Moses and Nepple, {Kenneth G.} and Preston, {Mark A.} and Soroush Rais-Bahrami and Resnick, {Matthew J.} and Siddiqui, {M. Minhaj} and Jonathan Silberstein and Singer, {Eric A.} and Sonn, {Geoffrey A.} and Preston Sprenkle and Stratton, {Kelly L.} and Jennifer Taylor and Jeffrey Tomaszewski and Matt Tollefson and Andrew Vickers and Wesley White and Lowrance, {William T.}",
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pages = "626--634",
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TY - JOUR

T1 - Gleason 6 prostate cancer

T2 - Translating biology into population health

AU - Eggener, Scott E.

AU - Badani, Ketan

AU - Barocas, Daniel A.

AU - Barrisford, Glen W.

AU - Cheng, Jed Sian

AU - Chin, Arnold I.

AU - Corcoran, Anthony

AU - Epstein, Jonathan I.

AU - George, Arvin K.

AU - Gupta, Gopal N.

AU - Hayn, Matthew H.

AU - Kauffman, Eric C.

AU - Lane, Brian

AU - Liss, Michael A.

AU - Mirza, Moben

AU - Morgan, Todd M.

AU - Moses, Kelvin

AU - Nepple, Kenneth G.

AU - Preston, Mark A.

AU - Rais-Bahrami, Soroush

AU - Resnick, Matthew J.

AU - Siddiqui, M. Minhaj

AU - Silberstein, Jonathan

AU - Singer, Eric A.

AU - Sonn, Geoffrey A.

AU - Sprenkle, Preston

AU - Stratton, Kelly L.

AU - Taylor, Jennifer

AU - Tomaszewski, Jeffrey

AU - Tollefson, Matt

AU - Vickers, Andrew

AU - White, Wesley

AU - Lowrance, William T.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Purpose Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management. Materials and Methods Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes. Results The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes. Conclusions The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.

AB - Purpose Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management. Materials and Methods Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes. Results The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes. Conclusions The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.

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