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PD34-03 TIMING OF THE CONFIRMATORY BIOPSY IN PROSTATE CANCER ACTIVE SURVEILLANCE: ANALYSIS OF THE CANARY PROSTATE CANCER ACTIVE SURVEILLANCE STUDY (PASS)
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e755
prostate volume were associated with decreased odds of reclassification compared to volume <30ml. CONCLUSIONS: In a cohort of low risk PCa patients on AS, reclassification rates on CBx were not statistically different regardless of timing of CBx. Furthermore, these rates are not trivial (21.3% overall). These data can be utilized in patient consultation for risk of occult adverse disease and when considering timing of CBx and initiation of AS. Source of Funding: Canary Foundation and the National Cancer Institute Early Detection Research Network
PD34-04 FREQUENCY OF PSA TESTING IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER. Leonard Bokhorst*, Arnout Alberts, Rotterdam, Netherlands; Yoshiyuki Kakehi, Kagawa, Japan; Antti Rannikko, Helsinki, Finland; Tom Pickles, Vancouver, Canada; Riccardo Valdagni, Milan, Italy; Chris Bangma, Monique Roobol, Rotterdam, Netherlands
Source of Funding: Joseph and Diane Steinberg Charitable Trust
PD34-03 TIMING OF THE CONFIRMATORY BIOPSY IN PROSTATE CANCER ACTIVE SURVEILLANCE: ANALYSIS OF THE CANARY PROSTATE CANCER ACTIVE SURVEILLANCE STUDY (PASS) Liam C. Macleod*, William J. Ellis, Lisa F. Newcomb, Yingye Zheng, Seattle, WA; James D. Brooks, Palo Alto, CA; Peter R. Carroll, San Francisco, CA; Martin E. Gleave, Vancouver, Canada; Raymond S. Lance, Virginia Beach, VA; Peter S. Nelson, Seattle, WA; Ian M. Thompson, San Antonio, TX; Andrew A. Wagner, Boston, MA; John T. Wei, Ann Arbor, MI; Hui-Yu Yang, Daniel W. Lin, Seattle, WA INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is gaining acceptance for men with low risk prostate cancer (PCa) to prevent over-treatment related morbidity. Variability exists regarding the timing of the confirmatory biopsy (CBx) after diagnostic biopsy (DBx) in AS protocols. We analyze the Prostate Cancer Active Surveillance (PASS) cohort, determining timing and rates of PCa adverse reclassification (henceforth called reclassification) on CBx. METHODS: Men (N¼422) with low risk PCA on AS were selected from the multicenter PASS cohort (1,067 screened). Criteria included enrollment within 1 year of DBx, receipt of CBx after enrollment, DBx with <34% cores involved and Gleason <¼6. Median PSA at diagnosis was 4.8 (IQR 3.7-6.3ng/ml). Reclassification was defined by increasing to Gleason >¼7 or to >¼34% cores involved. The PASS protocol requires a CBx within the first 6-12 months of DBx. The time interval from DBx to CBx in tertiles was 0-8.8, 8.9-12.4 and > 12.5 months. For simplicity, rates of reclassification on CBx were calculated at <8, 8-13 and >13 months post-DBx. Multivariable logistic regression determined association between reclassification, CBx timing, and other clinical and pathologic parameters. RESULTS: 90 men (21.3%) experienced reclassification on CBx. CBx was performed 11 months (median) after DBx (IQR 7.8-13.8). Rates of reclassification at <8, 8-13 and >13 months were 23.5% (28/ 199 CBx), 19.5% (34/174 CBx), and 21.7% (28/129 CBx), respectively (p¼0.71). On multivariable analysis factors associated with reclassification were BMI and prostate volume. BMI (categorized as <30, 30.1-34.9 and 35þ kg/m2) was associated with increased odds of reclassification in those with BMI > 35 kg/m2 (OR 6.1 95% CI 2.0, 18.7) compared to those with BMI < 30 kg/m2. Moderate (30-60ml; OR 0.28 95% CI 0.14, 0.57) and large (60mlþ; OR 0.14 95% CI 0.05, 0.40)
INTRODUCTION AND OBJECTIVES: Men on active surveillance for prostate cancer are followed using regular PSA tests. OBJECTIVE: To determine if the frequency of PSA testing in men on active surveillance for prostate cancer could be reduced. METHODS: A total of 4327 men with low-risk prostate cancer were included in the Prostate cancer Research International: Active Surveillance (PRIAS) study until October 2014. In this global active surveillance study men are prospectively followed using regular PSA tests, digital rectal examinations and prostate biopsies (figure 1). PSA is used to advise active treatment (if PSA doubling time (PSA-DT) <3 year), yearly biopsies (if PSA-DT is between 3-10 years) or a bone scan (if PSA >¼20). Kaplan-Meier curves were used to study follow-up time free of all three events. RESULTS: Mean follow-up on active surveillance was 1.7 years (range 0-13.8). After 4 years of follow-up 66.8%, 32.7%, and 97.5% of men did not have a PSA-DT <3 year, a PSA-DT between 3-10 years, and a PSA >¼20ng/ml, respectively. At 10 years of follow-up this remained rather stable at 66.1%, 19.4%, and 94.9% respectively, with only very few men having an event after 4 years (figure 2). Half yearly PSA testing after 4 years could have potentially advanced active treatment (PSA-DT <3 years) by 6 months in 0.7% of men, and advanced a bone scan (PSA >20ng/ml) in 2.6% of men (none were positive). Yearly biopsies (PSA-DT 3-10 years) would not be affected by decreasing PSA testing from every 6 months to once yearly. CONCLUSIONS: PSA testing in men on active surveillance could be reduced to once yearly after 4 years of follow-up as PSA progression after this time is rare and has little clinical impact.
Source of Funding: None
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e755
prostate volume were associated with decreased odds of reclassification compared to volume <30ml. CONCLUSIONS: In a cohort of low risk PCa patients on AS, reclassification rates on CBx were not statistically different regardless of timing of CBx. Furthermore, these rates are not trivial (21.3% overall). These data can be utilized in patient consultation for risk of occult adverse disease and when considering timing of CBx and initiation of AS. Source of Funding: Canary Foundation and the National Cancer Institute Early Detection Research Network
PD34-04 FREQUENCY OF PSA TESTING IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER. Leonard Bokhorst*, Arnout Alberts, Rotterdam, Netherlands; Yoshiyuki Kakehi, Kagawa, Japan; Antti Rannikko, Helsinki, Finland; Tom Pickles, Vancouver, Canada; Riccardo Valdagni, Milan, Italy; Chris Bangma, Monique Roobol, Rotterdam, Netherlands
Source of Funding: Joseph and Diane Steinberg Charitable Trust
PD34-03 TIMING OF THE CONFIRMATORY BIOPSY IN PROSTATE CANCER ACTIVE SURVEILLANCE: ANALYSIS OF THE CANARY PROSTATE CANCER ACTIVE SURVEILLANCE STUDY (PASS) Liam C. Macleod*, William J. Ellis, Lisa F. Newcomb, Yingye Zheng, Seattle, WA; James D. Brooks, Palo Alto, CA; Peter R. Carroll, San Francisco, CA; Martin E. Gleave, Vancouver, Canada; Raymond S. Lance, Virginia Beach, VA; Peter S. Nelson, Seattle, WA; Ian M. Thompson, San Antonio, TX; Andrew A. Wagner, Boston, MA; John T. Wei, Ann Arbor, MI; Hui-Yu Yang, Daniel W. Lin, Seattle, WA INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is gaining acceptance for men with low risk prostate cancer (PCa) to prevent over-treatment related morbidity. Variability exists regarding the timing of the confirmatory biopsy (CBx) after diagnostic biopsy (DBx) in AS protocols. We analyze the Prostate Cancer Active Surveillance (PASS) cohort, determining timing and rates of PCa adverse reclassification (henceforth called reclassification) on CBx. METHODS: Men (N¼422) with low risk PCA on AS were selected from the multicenter PASS cohort (1,067 screened). Criteria included enrollment within 1 year of DBx, receipt of CBx after enrollment, DBx with <34% cores involved and Gleason <¼6. Median PSA at diagnosis was 4.8 (IQR 3.7-6.3ng/ml). Reclassification was defined by increasing to Gleason >¼7 or to >¼34% cores involved. The PASS protocol requires a CBx within the first 6-12 months of DBx. The time interval from DBx to CBx in tertiles was 0-8.8, 8.9-12.4 and > 12.5 months. For simplicity, rates of reclassification on CBx were calculated at <8, 8-13 and >13 months post-DBx. Multivariable logistic regression determined association between reclassification, CBx timing, and other clinical and pathologic parameters. RESULTS: 90 men (21.3%) experienced reclassification on CBx. CBx was performed 11 months (median) after DBx (IQR 7.8-13.8). Rates of reclassification at <8, 8-13 and >13 months were 23.5% (28/ 199 CBx), 19.5% (34/174 CBx), and 21.7% (28/129 CBx), respectively (p¼0.71). On multivariable analysis factors associated with reclassification were BMI and prostate volume. BMI (categorized as <30, 30.1-34.9 and 35þ kg/m2) was associated with increased odds of reclassification in those with BMI > 35 kg/m2 (OR 6.1 95% CI 2.0, 18.7) compared to those with BMI < 30 kg/m2. Moderate (30-60ml; OR 0.28 95% CI 0.14, 0.57) and large (60mlþ; OR 0.14 95% CI 0.05, 0.40)
INTRODUCTION AND OBJECTIVES: Men on active surveillance for prostate cancer are followed using regular PSA tests. OBJECTIVE: To determine if the frequency of PSA testing in men on active surveillance for prostate cancer could be reduced. METHODS: A total of 4327 men with low-risk prostate cancer were included in the Prostate cancer Research International: Active Surveillance (PRIAS) study until October 2014. In this global active surveillance study men are prospectively followed using regular PSA tests, digital rectal examinations and prostate biopsies (figure 1). PSA is used to advise active treatment (if PSA doubling time (PSA-DT) <3 year), yearly biopsies (if PSA-DT is between 3-10 years) or a bone scan (if PSA >¼20). Kaplan-Meier curves were used to study follow-up time free of all three events. RESULTS: Mean follow-up on active surveillance was 1.7 years (range 0-13.8). After 4 years of follow-up 66.8%, 32.7%, and 97.5% of men did not have a PSA-DT <3 year, a PSA-DT between 3-10 years, and a PSA >¼20ng/ml, respectively. At 10 years of follow-up this remained rather stable at 66.1%, 19.4%, and 94.9% respectively, with only very few men having an event after 4 years (figure 2). Half yearly PSA testing after 4 years could have potentially advanced active treatment (PSA-DT <3 years) by 6 months in 0.7% of men, and advanced a bone scan (PSA >20ng/ml) in 2.6% of men (none were positive). Yearly biopsies (PSA-DT 3-10 years) would not be affected by decreasing PSA testing from every 6 months to once yearly. CONCLUSIONS: PSA testing in men on active surveillance could be reduced to once yearly after 4 years of follow-up as PSA progression after this time is rare and has little clinical impact.
Source of Funding: None