Date/Time
Date(s) - Thu 5 December
12:00 - 13:00
Location
Seminar Room, Malaghan Institute, VUW
Note: new date and time
Malaghan Institute seminar
Bio
Professor Brett Delahunt is an international authority on the pathology of prostate and kidney cancer. He is Emeritus Professor of Pathology and Molecular Medicine at the University of Otago and in 2023 was appointed Foreign Professor of Pathology at the Karolinska Institute in Stockholm, Sweden. He is Managing Partner and Director of Research of Aquesta Uropathology in Brisbane, which is the largest private uropathology laboratory in Australasia. He has served on the WHO Tumour Classification Panel for 25 years and for 11 years was President of the New Zealand Society of Pathologists. He recently completed a 14 year tenure as Editor of the journal Pathology. In 2015 he was appointed National Patron of the Prostate Cancer Foundation of New Zealand.
CARCINOMA OF THE PROSTATE: CURRENT CONTROVERSIES
The Gleason grading system is the lynchpin for the prognostic assessment of prostate cancer. Established in 1966 and published in its final form in 1977, a number of modifications of the Gleason system have been proposed. The 2005 modifications, formulated by the International Society of Urological Pathology (ISUP) at an international consensus conference, resulted in a significant grade inflation which, in turn, had a major impact on treatment recommendations. Further consensus recommendations following the meeting of the ISUP in 2014 led to the development of Grade Group system which was primarily proposed to assist patients to understand the nature of their disease. Both the nomenclature and the grading recommendations based on grade groups have come in for recent criticism with the observation that the original Gleason system provides greater prognostic information than more recent modifications.
Further controversy relates to the nature of intraductal carcinoma of the prostate, which was originally described as acinar carcinoma infiltrating prostatic ducts. While early Gleason grading studies did not differentiate between intraductal or stromal invasive carcinoma for grading purposes, recent recommendations are that the grade of intraductal carcinoma should not be included in the Gleason score. This has arisen from the suggestion that not all intraductal carcinoma is invasive and that some foci represent in situ tumours. This latter conclusion is based upon reports of three cases from the same institution and no further cases have been documented. A major problem with neglecting the grade of IDCP in a focus of prostatic carcinoma is that the intraductal carcinoma of the prostate is usually of higher grade and as a consequence it is likely cancers would be undergraded. This could mean that high grade tumours would be treated conservatively rather than with potentially curative surgery.