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MP78-15 PSA DOUBLING TIME FOLLOWING RADICAL PROSTATECTOMY: LONG TERM ANALYSIS OF LINEAR (VERSUS GEOMETRIC) PROGRESSION.
THE JOURNAL OF UROLOGYâ
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suggesting an increased risk of adverse oncologic outcomes in African American men with low risk (D’Amico criteria) disease, we assessed utilization trends of AS versus definitive treatment modalities from 20032011 with SEER Medicare claims. METHODS: From the SEER Medicare data, we identified 13376 Caucasian and African American men with low risk prostate cancer who were on surveillance. Surveillance was described as no treatment following their diagnosis of prostate cancer. The frequency of surveillance was compared between both groups. The mean time for leaving surveillance was estimated and compared between both groups. RESULTS: There was no significant change in the frequency of surveillance for each group of men over the study period. The time to any definitive treatment (radical prostatectomy, radiation, cryotherapy and proton beam) were identical in both groups of men. No significant change in AA men vs Caucasian men over the study period with patients ranging from 9-20% on AS as opposed to 9-21% Caucasian men on AS. CONCLUSIONS: Both African American and Caucasian men diagnosed with low risk prostate cancer equally utilized active surveillance over the time period studied with no statistical difference in the time to treatment. This marks a notable equalization of AS since the prior decade. Source of Funding: None
MP78-15 PSA DOUBLING TIME FOLLOWING RADICAL PROSTATECTOMY: LONG TERM ANALYSIS OF LINEAR (VERSUS GEOMETRIC) PROGRESSION.
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
Source of Funding: none
MP78-16 DOES PROSPECTIVELY ASSIGNED TERTIARY PATTERN 4 AFFECT PROGNOSIS OF GLEASON GRADE 3+3[6 PROSTATECTOMY PATIENTS? Michael Vacchio*, Kristopher Attwood, Diana Mehedint, Christine Murekeyisoni, Gissou Azabdaftari, Bo Xu, James Mohler, Eric Kauffman, Buffalo, NY
Blanca Morales, Douglas Skarecky, Thomas Ahlering*, Orange, CA INTRODUCTION AND OBJECTIVES: Studies support the prognostic impact of geometric progression of PSA via doubling times (PSAdt). Geometric BCR represents “malignant” progression whereas linear progression theoretically has “benign” implications. In this observational study we analyze a group of (untreated) men with BCR whose PSA progression appears linear with follow up >4 years. METHODS: From 1300 consecutive men, 175 (13.5%) men had BCR defined by 2 or more PSA values >0.2 and/or secondary prostate cancer treatment (ie hormonal, radiation therapy). 7/175 were excluded due to incomplete data; 32/175 (18%) underwent adjunctive treatment due to high risk (pN2+, etc); of the remaining 137, 91/175 had salvage treatment due to geometric progression (mean 22 mos.). 45/ 175 (26%) are untreated and the study group consists of 32 with a minimum 4 years follow up: mean follow up 6.6 years (range 48-123 mos). We have developed an electronic calculator that simultaneously tracts PSA geometric progression (ln(2)/slope) as well as linear progression (PSA value/time). Best fit estimates for linear versus geometric progression was calculated by R2. RESULTS: Table 1 depicts clinical and pathologic features between adjunctive, salvage and observation (untreated) groups. The immediate or adjunctive group in general had much higher clinical PSA values, Gleason scores and multiple lymph nodes positive. There were no significant differences in Gleason score, presence of surgical margin, pathological stage between the salvage and observed groups. We did note that 10 (11%) of the salvage group had been in the observation group for > 4 years. OBSERVATION GROUP. 32 or 18% of BCRs have been managed with observation without evidence of clinical/symptomatic recurrence. Two men however appear at clear risk of converting from linear to progression more the 48 months postop. Three men had 9 or more years of follow up. CONCLUSIONS: We make the observation that w18% of men with BCR appear to have BCR that is linear in nature. In this group we have seen long term metastasis and clinical progression free outcomes. The PSA kinetics and our findings suggest that a substantial percent of BCR is “benign” in nature and presumably managed with observation reserving treatment for geometric progression.
INTRODUCTION AND OBJECTIVES: Retrospective identification of tertiary pattern 4 in Gleason Grade (GG) 3+3¼6 prostatectomy specimens has been associated with prostate cancer (CaP) outcomes intermediate between those of pure GG6 and GG7, driving International Society of Urological Pathology (ISUP)recommendations in 2005 for tertiary pattern reporting when <5% of total cancer volume. However, validation of these outcomes with prospective grading has not since been performed. We investigated the oncologic impact of prospectively assigned tertiary pattern 4 in our GG3+3¼6 (GG6t4) prostatectomy patients. METHODS: Oncologic outcomes were retrospectively reviewed for 797 consecutive patients at a single National Comprehensive Cancer Network (NCCN)-designated cancer center with available follow up after prostatectomy for CaP prospectively graded as GG3+3¼6 (N¼231), GG6t4 (N¼56) or GG7 (N¼510) per 2005 ISUP guidelines . Biochemical failure-free survival (BFS) was compared in GG6t4 patients versus GG6 and GG7 patients by standard Kaplan-Meier methods and log rank testing. RESULTS: GG6t4 patients showed clinicopathologic features intermediate between those of GG6 and GG7 patients, including for preoperative PSA (mean 5.21 vs. 5.08 vs. 6.52, p <0.001, respectively) pT3 stage (26.8% vs. 7.3% vs. 34.9%, p <0.001, respectively), % prostate involvement (13.7% vs. 10.4% vs. 16.0%, p <0.001, respectively) and positive margins (19.6% vs. 13.0% vs. 33.8%, p<0.001, respectively). Median/mean follow up for GG6, GG6t4 and GG7 patients was 36/36, 32/ 26 and 31/26 months, respectively. Three-year BFS for GG6t4 patients was identical to that of GG6 patients (96% vs. 96%, p¼0.86), while significantly better than that of GG7 patients (85%, p¼0.028), including a trend towards improvement versus GG7 patients with primary pattern 3 (89, p¼0.115). There were no metastases in either the GG6t4 or GG6 groups compared to 4 metastatic cases in the GG7 group. CONCLUSIONS: Prospectively assigned tertiary Gleason pattern 4 is associated with a risk for adverse surgical pathology that is intermediate between those of pure GG6 and GG7, however oncologic outcomes with intermediate-term follow up are no different than pure GG6. Longer term follow-up is needed to determine the prognostic significance of prospectively assigned tertiary pattern 4.
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suggesting an increased risk of adverse oncologic outcomes in African American men with low risk (D’Amico criteria) disease, we assessed utilization trends of AS versus definitive treatment modalities from 20032011 with SEER Medicare claims. METHODS: From the SEER Medicare data, we identified 13376 Caucasian and African American men with low risk prostate cancer who were on surveillance. Surveillance was described as no treatment following their diagnosis of prostate cancer. The frequency of surveillance was compared between both groups. The mean time for leaving surveillance was estimated and compared between both groups. RESULTS: There was no significant change in the frequency of surveillance for each group of men over the study period. The time to any definitive treatment (radical prostatectomy, radiation, cryotherapy and proton beam) were identical in both groups of men. No significant change in AA men vs Caucasian men over the study period with patients ranging from 9-20% on AS as opposed to 9-21% Caucasian men on AS. CONCLUSIONS: Both African American and Caucasian men diagnosed with low risk prostate cancer equally utilized active surveillance over the time period studied with no statistical difference in the time to treatment. This marks a notable equalization of AS since the prior decade. Source of Funding: None
MP78-15 PSA DOUBLING TIME FOLLOWING RADICAL PROSTATECTOMY: LONG TERM ANALYSIS OF LINEAR (VERSUS GEOMETRIC) PROGRESSION.
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
Source of Funding: none
MP78-16 DOES PROSPECTIVELY ASSIGNED TERTIARY PATTERN 4 AFFECT PROGNOSIS OF GLEASON GRADE 3+3[6 PROSTATECTOMY PATIENTS? Michael Vacchio*, Kristopher Attwood, Diana Mehedint, Christine Murekeyisoni, Gissou Azabdaftari, Bo Xu, James Mohler, Eric Kauffman, Buffalo, NY
Blanca Morales, Douglas Skarecky, Thomas Ahlering*, Orange, CA INTRODUCTION AND OBJECTIVES: Studies support the prognostic impact of geometric progression of PSA via doubling times (PSAdt). Geometric BCR represents “malignant” progression whereas linear progression theoretically has “benign” implications. In this observational study we analyze a group of (untreated) men with BCR whose PSA progression appears linear with follow up >4 years. METHODS: From 1300 consecutive men, 175 (13.5%) men had BCR defined by 2 or more PSA values >0.2 and/or secondary prostate cancer treatment (ie hormonal, radiation therapy). 7/175 were excluded due to incomplete data; 32/175 (18%) underwent adjunctive treatment due to high risk (pN2+, etc); of the remaining 137, 91/175 had salvage treatment due to geometric progression (mean 22 mos.). 45/ 175 (26%) are untreated and the study group consists of 32 with a minimum 4 years follow up: mean follow up 6.6 years (range 48-123 mos). We have developed an electronic calculator that simultaneously tracts PSA geometric progression (ln(2)/slope) as well as linear progression (PSA value/time). Best fit estimates for linear versus geometric progression was calculated by R2. RESULTS: Table 1 depicts clinical and pathologic features between adjunctive, salvage and observation (untreated) groups. The immediate or adjunctive group in general had much higher clinical PSA values, Gleason scores and multiple lymph nodes positive. There were no significant differences in Gleason score, presence of surgical margin, pathological stage between the salvage and observed groups. We did note that 10 (11%) of the salvage group had been in the observation group for > 4 years. OBSERVATION GROUP. 32 or 18% of BCRs have been managed with observation without evidence of clinical/symptomatic recurrence. Two men however appear at clear risk of converting from linear to progression more the 48 months postop. Three men had 9 or more years of follow up. CONCLUSIONS: We make the observation that w18% of men with BCR appear to have BCR that is linear in nature. In this group we have seen long term metastasis and clinical progression free outcomes. The PSA kinetics and our findings suggest that a substantial percent of BCR is “benign” in nature and presumably managed with observation reserving treatment for geometric progression.
INTRODUCTION AND OBJECTIVES: Retrospective identification of tertiary pattern 4 in Gleason Grade (GG) 3+3¼6 prostatectomy specimens has been associated with prostate cancer (CaP) outcomes intermediate between those of pure GG6 and GG7, driving International Society of Urological Pathology (ISUP)recommendations in 2005 for tertiary pattern reporting when <5% of total cancer volume. However, validation of these outcomes with prospective grading has not since been performed. We investigated the oncologic impact of prospectively assigned tertiary pattern 4 in our GG3+3¼6 (GG6t4) prostatectomy patients. METHODS: Oncologic outcomes were retrospectively reviewed for 797 consecutive patients at a single National Comprehensive Cancer Network (NCCN)-designated cancer center with available follow up after prostatectomy for CaP prospectively graded as GG3+3¼6 (N¼231), GG6t4 (N¼56) or GG7 (N¼510) per 2005 ISUP guidelines . Biochemical failure-free survival (BFS) was compared in GG6t4 patients versus GG6 and GG7 patients by standard Kaplan-Meier methods and log rank testing. RESULTS: GG6t4 patients showed clinicopathologic features intermediate between those of GG6 and GG7 patients, including for preoperative PSA (mean 5.21 vs. 5.08 vs. 6.52, p <0.001, respectively) pT3 stage (26.8% vs. 7.3% vs. 34.9%, p <0.001, respectively), % prostate involvement (13.7% vs. 10.4% vs. 16.0%, p <0.001, respectively) and positive margins (19.6% vs. 13.0% vs. 33.8%, p<0.001, respectively). Median/mean follow up for GG6, GG6t4 and GG7 patients was 36/36, 32/ 26 and 31/26 months, respectively. Three-year BFS for GG6t4 patients was identical to that of GG6 patients (96% vs. 96%, p¼0.86), while significantly better than that of GG7 patients (85%, p¼0.028), including a trend towards improvement versus GG7 patients with primary pattern 3 (89, p¼0.115). There were no metastases in either the GG6t4 or GG6 groups compared to 4 metastatic cases in the GG7 group. CONCLUSIONS: Prospectively assigned tertiary Gleason pattern 4 is associated with a risk for adverse surgical pathology that is intermediate between those of pure GG6 and GG7, however oncologic outcomes with intermediate-term follow up are no different than pure GG6. Longer term follow-up is needed to determine the prognostic significance of prospectively assigned tertiary pattern 4.