ASA, when I cite this I always usually point out that G6 itself cannot
metastasize. Above I said that 10% of prostate-confined G6 men are high metastasis risk
. I usually word it with something longer, like "high risk for developing higher-grade lesions with a risk of metastasis". I did said above "These are percentages for met risk within 5 years and not risk of having mets at time of diagnosis if the stage is pT2" This is why there is increasing emphasis on genomic screening of men.
The data is from a seminal study of the Decipher Biopsy test:Decipher correlation patterns post prostatectomy: initial experience from 2342 prospective patients
(2016, Full Text)
See Table 2. Note that these were cases of G6 (3+3) confirmed at RP and included no upgrades. A good number of G6 men, of course, do
harbor undiagnosed lesions >6 (RP upgrades) and therefore the number of men with G6 biopsies with high-risk for mets is higher
than 10%. Note that for confirmed G6 that has grown through the capsule (pT3a), high risk jumps to 16%.
(Unfortunately, genomic testing of biopsied tissue, in the case of Decipher, agrees with the test run after RP on the same patient only 70% of the time for the same reason we have RP upgrades: the biopsy misses a more serious lesion).
I wouldn't enter AS if I had a G6 biopsy and a high-risk result from a genomics test.
Post Edited (DjinTonic) : 11/15/2020 3:48:21 PM (GMT-7)