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PD55-11 IS FAVORABLE INTERMEDIATE RISK PROSTATE CANCER REALLY FAVORABLE? IMPLICATIONS FOR ACTIVE SURVEILLANCE STRATEGIES
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
RESULTS: 3669 patients underwent RP between 1/1/04 and 12/31/15. Of these, 1454, 251 and 1361 patients fulfilled criteria for very low/low, favorable intermediate, and unfavorable intermediate-risk groups, respectively. Median follow-up was 37 months. Patients in the favorable intermediate group had significantly higher rates of Gleason score upgrading (16% vs 6%; p<0.001) and non organ-confined disease (16% vs 11%; p¼0.035) than those in low risk group. Time to biochemical recurrence for the favorable intermediate group did not differ significantly from the low risk group (p¼0.057), but was significantly longer than unfavorable intermediates (p¼0.003) (Figure 1). CONCLUSIONS: Compared to very low/low risk prostate cancer patients, men with favorable intermediate-risk disease had significantly higher rates of more aggressive, non-organ confined disease at RP, and trended toward worse biochemical progression free survival. However, when compared to unfavorable intermediate risk patients, it appears the magnitude of these differences would not preclude AS as a reasonable option for appropriately selected patients with favorable intermediate risk prostate cancer.
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in Table 1, with the FIR group demonstrating rates more similar to VLR/ LR than UIR. A Cox regression analysis controlling for age, ethnicity and prior biopsy status demonstrated similar hazard ratios (HR) for developing BCR in the LR (OR 6.1, 9% CI 1.3,28.8) and FIR (OR 5.88, 95% CI 1.3,25.8) groups, as opposed to higher HR in UIR ( OR 14.3, 95% CI 3.5, 59.1), when compared to the reference group (VLR). CONCLUSIONS: Patients with FIR CaP have proportional rates of adverse pathology compared with lower risk CaP. However, intermediate-term clinical outcomes suggest more favorable clinical behavior, which may be related to the biology of these tumors. This has significant implications when considering patients for AS.
Source of Funding: None
PD55-12
Source of Funding: None.
PD55-11 IS FAVORABLE INTERMEDIATE RISK PROSTATE CANCER REALLY FAVORABLE? IMPLICATIONS FOR ACTIVE SURVEILLANCE STRATEGIES Samuel Haywood*, Yaw Nyame, Helen Liang, Eric Klein, Andrew Stephenson, Cleveland, OH INTRODUCTION AND OBJECTIVES: Select patients with Gleason 7 prostate cancer (CaP) are managed by active surveillance (AS) at our institution. In fact, the most recent National Comprehensive Cancer Network (NCCN) guidelines have endorsed use of AS in patients with favorable-intermediate risk (FIR) CaP. The aim of this study is to assess oncologic and pathologic findings at radical prostatectomy (RP) in men classified by the NCCN risk strata. METHODS: This is an observational study of prospectively collected data of patients undergoing RP from 2005 to 2015. FIR CaP was defined as: Gleason grade 3+4, 50% of cores positive, and no more than one of the following: PSA >10 or clinical stage >T2a. Rates of adverse pathology at RP and biochemical recurrence (BCR) were compared in stratified analysis by NCCN risk grouping: very-low risk (VLR), low-risk (LR), FIR, and those with intermediate risk disease not meeting FIR criteria, termed unfavorable intermediate risk (UIR). Adverse pathology was defined as Gleason grade >3+4, extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI), or a composite adverse pathology variable (AP). RESULTS: There were 1413 patients identified, of which 353 met criteria for FIR. The mean age of the entire cohort was 60.8 6.7 years. with median follow-up time of 30.0 (IQR 11.7-42.2) months. Rates of AP increased accordingly with risk group (Table 1). The FIR group showed rates of AP between LR and UIR. On age-adjusted logistic regression analysis, risk grouping significantly correlated with AP (p<0.05). The cumulative survival-free BCR probabilities are also listed
OLDER AGE AT DIAGNOSIS AND DISEASE VOLUME PREDICT UPGRADING ON CONFIRMATORY BIOPSY IN PROSTATE CANCER PATIENTS BEING CONSIDERED FOR ACTIVE SURVEILLANCE Charles Dai*, Vishnu Ganesan, Nima Almassi, Yaw Nyame, Daniel Greene, Daniel Hettel, Alice Crane, Joseph Zabell, Anna Zampini, Samuel Haywood, Hans Arora, Chad Reichard, Ahmed El-Shafei, Robert Stein, Khaled Fareed, Michael Gong, J. Stephen Jones, Andrew J. Stephenson, Eric Klein, Cleveland, OH INTRODUCTION AND OBJECTIVES: Prior single-institution retrospective studies suggest that age may independently predict risk of Gleason progression on repeat biopsy following a diagnosis of low risk prostate cancer (PCa). Older men experience higher rates of PCaspecific mortality; therefore, the appropriateness of active surveillance may differ in an older patient population and is influenced by the probability of undersampling for occult higher grade disease. Furthermore, the clinicopathologic features most useful in guiding decisions to re-biopsy remain poorly defined. We therefore sought to investigate the risk of Gleason upgrading on repeat biopsy, as well as the features most suggestive of potential Gleason misclassification. METHODS: We retrospectively reviewed charts of 635 men on active surveillance at our institution between 2002 to 2015. Demographic and clinicopathologic features including age, race, initial PSA, prostate volume, clinical staging, and biopsy findings were collected. Within this population, we identified 556 men who were diagnosed with Gleason 3+3 disease on initial biopsy, of whom 406 received a documented confirmatory biopsy within 1 year of diagnosis. Logistic regression modeling was performed to determine features associated with detection of Gleason 7 or higher disease on confirmatory biopsy. RESULTS: Eighty-five of 406 patients (21%) with initial Gleason 6 disease who received a repeat confirmatory biopsy were found to have grade reclassification. On multivariable analysis, older age (per year OR 1.07; 95% CI 1.02-1.11; p ¼ 0.003) and number of positive cores (per core, OR 1.38, 95% CI 1.10-1.73; p ¼ 0.05) were significantly associated with reclassification on confirmatory biopsy (Table 1). Initial prostate volume, clinical stage, and PSA were not found to be associated with this risk.
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
RESULTS: 3669 patients underwent RP between 1/1/04 and 12/31/15. Of these, 1454, 251 and 1361 patients fulfilled criteria for very low/low, favorable intermediate, and unfavorable intermediate-risk groups, respectively. Median follow-up was 37 months. Patients in the favorable intermediate group had significantly higher rates of Gleason score upgrading (16% vs 6%; p<0.001) and non organ-confined disease (16% vs 11%; p¼0.035) than those in low risk group. Time to biochemical recurrence for the favorable intermediate group did not differ significantly from the low risk group (p¼0.057), but was significantly longer than unfavorable intermediates (p¼0.003) (Figure 1). CONCLUSIONS: Compared to very low/low risk prostate cancer patients, men with favorable intermediate-risk disease had significantly higher rates of more aggressive, non-organ confined disease at RP, and trended toward worse biochemical progression free survival. However, when compared to unfavorable intermediate risk patients, it appears the magnitude of these differences would not preclude AS as a reasonable option for appropriately selected patients with favorable intermediate risk prostate cancer.
e1055
in Table 1, with the FIR group demonstrating rates more similar to VLR/ LR than UIR. A Cox regression analysis controlling for age, ethnicity and prior biopsy status demonstrated similar hazard ratios (HR) for developing BCR in the LR (OR 6.1, 9% CI 1.3,28.8) and FIR (OR 5.88, 95% CI 1.3,25.8) groups, as opposed to higher HR in UIR ( OR 14.3, 95% CI 3.5, 59.1), when compared to the reference group (VLR). CONCLUSIONS: Patients with FIR CaP have proportional rates of adverse pathology compared with lower risk CaP. However, intermediate-term clinical outcomes suggest more favorable clinical behavior, which may be related to the biology of these tumors. This has significant implications when considering patients for AS.
Source of Funding: None
PD55-12
Source of Funding: None.
PD55-11 IS FAVORABLE INTERMEDIATE RISK PROSTATE CANCER REALLY FAVORABLE? IMPLICATIONS FOR ACTIVE SURVEILLANCE STRATEGIES Samuel Haywood*, Yaw Nyame, Helen Liang, Eric Klein, Andrew Stephenson, Cleveland, OH INTRODUCTION AND OBJECTIVES: Select patients with Gleason 7 prostate cancer (CaP) are managed by active surveillance (AS) at our institution. In fact, the most recent National Comprehensive Cancer Network (NCCN) guidelines have endorsed use of AS in patients with favorable-intermediate risk (FIR) CaP. The aim of this study is to assess oncologic and pathologic findings at radical prostatectomy (RP) in men classified by the NCCN risk strata. METHODS: This is an observational study of prospectively collected data of patients undergoing RP from 2005 to 2015. FIR CaP was defined as: Gleason grade 3+4, 50% of cores positive, and no more than one of the following: PSA >10 or clinical stage >T2a. Rates of adverse pathology at RP and biochemical recurrence (BCR) were compared in stratified analysis by NCCN risk grouping: very-low risk (VLR), low-risk (LR), FIR, and those with intermediate risk disease not meeting FIR criteria, termed unfavorable intermediate risk (UIR). Adverse pathology was defined as Gleason grade >3+4, extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI), or a composite adverse pathology variable (AP). RESULTS: There were 1413 patients identified, of which 353 met criteria for FIR. The mean age of the entire cohort was 60.8 6.7 years. with median follow-up time of 30.0 (IQR 11.7-42.2) months. Rates of AP increased accordingly with risk group (Table 1). The FIR group showed rates of AP between LR and UIR. On age-adjusted logistic regression analysis, risk grouping significantly correlated with AP (p<0.05). The cumulative survival-free BCR probabilities are also listed
OLDER AGE AT DIAGNOSIS AND DISEASE VOLUME PREDICT UPGRADING ON CONFIRMATORY BIOPSY IN PROSTATE CANCER PATIENTS BEING CONSIDERED FOR ACTIVE SURVEILLANCE Charles Dai*, Vishnu Ganesan, Nima Almassi, Yaw Nyame, Daniel Greene, Daniel Hettel, Alice Crane, Joseph Zabell, Anna Zampini, Samuel Haywood, Hans Arora, Chad Reichard, Ahmed El-Shafei, Robert Stein, Khaled Fareed, Michael Gong, J. Stephen Jones, Andrew J. Stephenson, Eric Klein, Cleveland, OH INTRODUCTION AND OBJECTIVES: Prior single-institution retrospective studies suggest that age may independently predict risk of Gleason progression on repeat biopsy following a diagnosis of low risk prostate cancer (PCa). Older men experience higher rates of PCaspecific mortality; therefore, the appropriateness of active surveillance may differ in an older patient population and is influenced by the probability of undersampling for occult higher grade disease. Furthermore, the clinicopathologic features most useful in guiding decisions to re-biopsy remain poorly defined. We therefore sought to investigate the risk of Gleason upgrading on repeat biopsy, as well as the features most suggestive of potential Gleason misclassification. METHODS: We retrospectively reviewed charts of 635 men on active surveillance at our institution between 2002 to 2015. Demographic and clinicopathologic features including age, race, initial PSA, prostate volume, clinical staging, and biopsy findings were collected. Within this population, we identified 556 men who were diagnosed with Gleason 3+3 disease on initial biopsy, of whom 406 received a documented confirmatory biopsy within 1 year of diagnosis. Logistic regression modeling was performed to determine features associated with detection of Gleason 7 or higher disease on confirmatory biopsy. RESULTS: Eighty-five of 406 patients (21%) with initial Gleason 6 disease who received a repeat confirmatory biopsy were found to have grade reclassification. On multivariable analysis, older age (per year OR 1.07; 95% CI 1.02-1.11; p ¼ 0.003) and number of positive cores (per core, OR 1.38, 95% CI 1.10-1.73; p ¼ 0.05) were significantly associated with reclassification on confirmatory biopsy (Table 1). Initial prostate volume, clinical stage, and PSA were not found to be associated with this risk.