Tall Allen said...
Statement 33 does not in any way contradict what I said. Klotz started his protocol allowing in patients with GS 3+4. So "adverse reclassification" would have to be GS 4+3. Here's what he wrote:
The authors' [Klotz et al.] approach has been to use PSADT less than 3 years (20% of patients) or grade progression to Gleason 4+3 or higher (5%).
He's made some changes since the start. He now only allows GS 3+4 if pattern 4 is less than 10%. He also eliminated PSADT < 3 years as a treatment trigger. PRIAS, in contrast, uses it.Allen, wouldn't "adverse reclassification" include a change from favorable intermediate risk to unfavorable
intermediate risk? Say, you were 3+4 and pattern 4 was 5%. With just a little pattern 4, you are almost 3+3 and could qualify for AS... sounds reasonable.
But if pattern 4 rose to 40% or PSA jumped to 15 (2 intermediate risk factors), I would think just logically that remaining on AS might not be sound reasoning any more... even though you are still 3+4...unless of course there were hard statistical data to prove that it was OK!
Hence adverse reclassification may not be strictly be grade progression to 4+3, but a reclassification from favorable to unfavorable
Dx Age 55 Dec '16, PSA 4.313
MP MRI Jan '17: PR 5, Bn Scan -ve
Jan '17 MRI Fs BX 4 of 12 +ve G7 (3+4)
RALP Feb 2, 2017
Path: G7 (3+4), PT2c ECE, Margins, LN, SV all -ve
2017: 0.029-0.059(Siemens); <0.008(Abbott); <0.03(NCCS); < 0.01(Bck Coulter, NUS),<0.02(Bck Coulter, Quest); <0.006(Roche, Labcorp)
Jan 2018: <0.008 (Abbott); <0.03(NCCS)