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MP39-13 BASELINE PROSTATE-SPECIFIC ANTIGEN (PSA) LEVELS IN MIDLIFE PREDICT TOTAL AND AGGRESSIVE PROSTATE CANCER IN AFRICAN-AMERICAN MEN
THE JOURNAL OF UROLOGYâ
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Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
pathology. Therefore, MRGB adds additional value when assessing especially this subset of patients for AS. Source of Funding: None.
MP39-13 BASELINE PROSTATE-SPECIFIC ANTIGEN (PSA) LEVELS IN MIDLIFE PREDICT TOTAL AND AGGRESSIVE PROSTATE CANCER IN AFRICAN-AMERICAN MEN Mark Preston*, Kathryn Wilson, Travis Gerke, Boston, MA; Sigrid Carlsson, Daniel Sjoberg, New York, NY; Adam Kibel, Quoc-Dien Trinh, Boston, MA; Lisa Signorello, Bethesda, MD; Mark Steinwandel, Rockville, MD; Andrew Vickers, Hans Lilja, New York, NY; Lorelei Mucci, Boston, MA
Source of Funding: none
MP39-12 GLEASON MISCLASSIFICATION IN DIFFERENT ACTIVE SURVEILLANCE PROTOCOLS: CORRELATION BETWEEN FUSION BIOPSIES MRI-ULTRASOUND FUSION GUIDED BIOPSY AND FINAL RADICAL PROSTATECTOMY SPECIMEN Sami-Ramzi Leyh-Bannurah*, Montreal, Canada; Paolo Dell’Oglio, Milano, Italy; Dirk Beyersdorff, Georg Salomon, Markus Graefen, €us, Hamburg, Germany; Wolfgang Picker, Oslo, Norway; Lars Buda Hamburg, Germany INTRODUCTION AND OBJECTIVES: Biopsy Gleason is the main tool to stratify prostate cancer patients (PCa) into risk groups and advise treatment options such as active surveillance (AS) in low-risk patients. Most AS protocols cover low risk patients and only a limited number of protocols include patients harbouring Gleason 4 pattern. Our aim was to assess upgrading risks in different patient risk groups by using final radical prostatectomy (RP) specimen. METHODS: 152 consecutive patients received systematic random biopsy (SB) and MRI-Ultrasound fusion guided biopsy (MRGB) in the same session before surgery. Gleason proportions (%) were calculated for biopsy and final RP specimens and compared with final RP as gold standard. RESULTS: Correlation rates assessed the detection of highest correct Gleason pattern compared to final pathology were 76 (49.3%) for SB, 99 (65.1%) for MRGB and 121 (79.6%) for combined biopsies. Similarly, upgrading in RRP occurred in 53 (34.9%), 30 (19.7%) and 31(20.4%) patients, respectively. Conversely, missed detection rates were identical in random and targeted with 23 (15.1%) patients each and none in combined approach. Correlation with final pathology showed 13(56.5%) and 12(52.2%) high-risk PCa missed within random and targeted biopsies, respectively. Subanalyses revealed that upgrading occurred mostly in biopsies that yielded Gleason score 6 PCa. However, Gleason score 6 biopsies decreased from 37(24.3%) patients in SB to 21(13.8%) in MRGB. Nonetheless, within those 21 patients, 16(76.2%). upgraded to Gleason 4/5. Accordingly, presence of Gleason pattern 4/5 was correctly identified in SB in 92(60.5%), 108(71.1%) in MRGB and 129(84.9%) patients combined. CONCLUSIONS: When compared to final pathology, MRGB and SB combined best reduced the risk of upgrading in all biopsy risk groups. However, the proportion of misclassification in Gleason 3+3 patients remains problematic (76.2%). Conversely, the detection of Gleason 4 pattern by MRGB is highly accurate compared with final
INTRODUCTION AND OBJECTIVES: Prostate specific antigen (PSA) level in midlife predicts prostate cancer (PCa) mortality in Caucasian populations. It is poorly studied whether PSA measured during midlife predicts aggressive PCa among African-American men, a group for which PCa disparities exist. METHODS: We performed a nested case-control study among African-American men age 40-65 years who gave blood at enrollment in the Southern Community Cohort Study between 2002-2009 and followed for median of 9 years. Baseline kallikrein levels (total PSA, free PSA, intact PSA, and human kallikrein 2 [hK2]) were measured in 197 PCa cases and 569 age-matched controls. 55 participants had aggressive disease defined as Gleason ¼4+3¼7, AJCC Stage III or IV, or cancer-specific death. Exact conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between PSA and risk of total and aggressive PCa. Area under the curve (AUC) for prediction of total and aggressive disease by total PSA and a previously reported four-kallikrein risk score was calculated using logistic regression. RESULTS: Median total PSA among the controls was 0.72, 0.80, 0.94, and 1.03 ng/mL for men age 40-49, 50-54 and 55-59, and 60-64 years, respectively. Risk of total PCa was strongly associated with baseline total PSA levels in midlife. Total PSA was also highly predictive of risk of aggressive disease. All 22 aggressive cases in men aged <55 years occurred among those with PSA above the age-specific median; among men 40-49 years, all 9 cases of aggressive disease were among those with PSA >90th percentile. Across age groups, the odds ratio of aggressive disease for PSA greater than the 90th percentile vs. less than the median was 38.8 (95% CI: 10.0-237), using age-specific cut-points. PSA-levels in midlife predicted total (AUC 0.88, 95% CI 0.85-0.91) and aggressive (AUC 0.87, 95% CI 0.81-0.92) prostate cancer with high discrimination. Among men with total PSA > 2 ng/ml, the four-kallikrein risk score improved prediction of aggressive disease compared to total PSA alone. CONCLUSIONS: PSA level in midlife strongly predicted total and aggressive PCa in a cohort of African American men subject to opportunistic screening. These data provide further evidence for the utility of risk-stratified screening based on mid-life PSA. Source of Funding: David A. Mazzone Prostate Cancer Disparities Award.
MP39-14 IMPACT OF THE 2012 UNITED STATES PREVENTIVE SERVICES TASK FORCE RECOMMENDATION AGAINST PROSTATE SPECIFIC ANTIGEN SCREENING ON PROSTATE CANCER RISK GROUP STRATIFICATION Deepansh Dalela*, Detroit, MI; Bjorn Loeppenberg, Boston, MA; Akshay Sood, Jesse Sammon, Patrick Karabon, Detroit, MI; Maxine Sun, Quoc-Dien Trinh, Boston, MA; Wooju Jeong, James Peabody, Mani Menon, Detroit, MI; Firas Abdollah, Royal Oak, MI INTRODUCTION AND OBJECTIVES: The United States Preventive Services Task Force (USPSTF) in 2012 recommended against
e546
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
pathology. Therefore, MRGB adds additional value when assessing especially this subset of patients for AS. Source of Funding: None.
MP39-13 BASELINE PROSTATE-SPECIFIC ANTIGEN (PSA) LEVELS IN MIDLIFE PREDICT TOTAL AND AGGRESSIVE PROSTATE CANCER IN AFRICAN-AMERICAN MEN Mark Preston*, Kathryn Wilson, Travis Gerke, Boston, MA; Sigrid Carlsson, Daniel Sjoberg, New York, NY; Adam Kibel, Quoc-Dien Trinh, Boston, MA; Lisa Signorello, Bethesda, MD; Mark Steinwandel, Rockville, MD; Andrew Vickers, Hans Lilja, New York, NY; Lorelei Mucci, Boston, MA
Source of Funding: none
MP39-12 GLEASON MISCLASSIFICATION IN DIFFERENT ACTIVE SURVEILLANCE PROTOCOLS: CORRELATION BETWEEN FUSION BIOPSIES MRI-ULTRASOUND FUSION GUIDED BIOPSY AND FINAL RADICAL PROSTATECTOMY SPECIMEN Sami-Ramzi Leyh-Bannurah*, Montreal, Canada; Paolo Dell’Oglio, Milano, Italy; Dirk Beyersdorff, Georg Salomon, Markus Graefen, €us, Hamburg, Germany; Wolfgang Picker, Oslo, Norway; Lars Buda Hamburg, Germany INTRODUCTION AND OBJECTIVES: Biopsy Gleason is the main tool to stratify prostate cancer patients (PCa) into risk groups and advise treatment options such as active surveillance (AS) in low-risk patients. Most AS protocols cover low risk patients and only a limited number of protocols include patients harbouring Gleason 4 pattern. Our aim was to assess upgrading risks in different patient risk groups by using final radical prostatectomy (RP) specimen. METHODS: 152 consecutive patients received systematic random biopsy (SB) and MRI-Ultrasound fusion guided biopsy (MRGB) in the same session before surgery. Gleason proportions (%) were calculated for biopsy and final RP specimens and compared with final RP as gold standard. RESULTS: Correlation rates assessed the detection of highest correct Gleason pattern compared to final pathology were 76 (49.3%) for SB, 99 (65.1%) for MRGB and 121 (79.6%) for combined biopsies. Similarly, upgrading in RRP occurred in 53 (34.9%), 30 (19.7%) and 31(20.4%) patients, respectively. Conversely, missed detection rates were identical in random and targeted with 23 (15.1%) patients each and none in combined approach. Correlation with final pathology showed 13(56.5%) and 12(52.2%) high-risk PCa missed within random and targeted biopsies, respectively. Subanalyses revealed that upgrading occurred mostly in biopsies that yielded Gleason score 6 PCa. However, Gleason score 6 biopsies decreased from 37(24.3%) patients in SB to 21(13.8%) in MRGB. Nonetheless, within those 21 patients, 16(76.2%). upgraded to Gleason 4/5. Accordingly, presence of Gleason pattern 4/5 was correctly identified in SB in 92(60.5%), 108(71.1%) in MRGB and 129(84.9%) patients combined. CONCLUSIONS: When compared to final pathology, MRGB and SB combined best reduced the risk of upgrading in all biopsy risk groups. However, the proportion of misclassification in Gleason 3+3 patients remains problematic (76.2%). Conversely, the detection of Gleason 4 pattern by MRGB is highly accurate compared with final
INTRODUCTION AND OBJECTIVES: Prostate specific antigen (PSA) level in midlife predicts prostate cancer (PCa) mortality in Caucasian populations. It is poorly studied whether PSA measured during midlife predicts aggressive PCa among African-American men, a group for which PCa disparities exist. METHODS: We performed a nested case-control study among African-American men age 40-65 years who gave blood at enrollment in the Southern Community Cohort Study between 2002-2009 and followed for median of 9 years. Baseline kallikrein levels (total PSA, free PSA, intact PSA, and human kallikrein 2 [hK2]) were measured in 197 PCa cases and 569 age-matched controls. 55 participants had aggressive disease defined as Gleason ¼4+3¼7, AJCC Stage III or IV, or cancer-specific death. Exact conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between PSA and risk of total and aggressive PCa. Area under the curve (AUC) for prediction of total and aggressive disease by total PSA and a previously reported four-kallikrein risk score was calculated using logistic regression. RESULTS: Median total PSA among the controls was 0.72, 0.80, 0.94, and 1.03 ng/mL for men age 40-49, 50-54 and 55-59, and 60-64 years, respectively. Risk of total PCa was strongly associated with baseline total PSA levels in midlife. Total PSA was also highly predictive of risk of aggressive disease. All 22 aggressive cases in men aged <55 years occurred among those with PSA above the age-specific median; among men 40-49 years, all 9 cases of aggressive disease were among those with PSA >90th percentile. Across age groups, the odds ratio of aggressive disease for PSA greater than the 90th percentile vs. less than the median was 38.8 (95% CI: 10.0-237), using age-specific cut-points. PSA-levels in midlife predicted total (AUC 0.88, 95% CI 0.85-0.91) and aggressive (AUC 0.87, 95% CI 0.81-0.92) prostate cancer with high discrimination. Among men with total PSA > 2 ng/ml, the four-kallikrein risk score improved prediction of aggressive disease compared to total PSA alone. CONCLUSIONS: PSA level in midlife strongly predicted total and aggressive PCa in a cohort of African American men subject to opportunistic screening. These data provide further evidence for the utility of risk-stratified screening based on mid-life PSA. Source of Funding: David A. Mazzone Prostate Cancer Disparities Award.
MP39-14 IMPACT OF THE 2012 UNITED STATES PREVENTIVE SERVICES TASK FORCE RECOMMENDATION AGAINST PROSTATE SPECIFIC ANTIGEN SCREENING ON PROSTATE CANCER RISK GROUP STRATIFICATION Deepansh Dalela*, Detroit, MI; Bjorn Loeppenberg, Boston, MA; Akshay Sood, Jesse Sammon, Patrick Karabon, Detroit, MI; Maxine Sun, Quoc-Dien Trinh, Boston, MA; Wooju Jeong, James Peabody, Mani Menon, Detroit, MI; Firas Abdollah, Royal Oak, MI INTRODUCTION AND OBJECTIVES: The United States Preventive Services Task Force (USPSTF) in 2012 recommended against