MP12-02 EFFECTS OF INITIAL GLEASON GRADE ON OUTCOMES DURING ACTIVE SURVEILLANCE FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I1 Apr 2018MP12-02 EFFECTS OF INITIAL GLEASON GRADE ON OUTCOMES DURING ACTIVE SURVEILLANCE FOR PROSTATE CANCER Selma Masic, Janet Cowan, Hao Nguyen, Katsuto Shinohara, Matthew Cooperberg, and Peter Carroll Selma MasicSelma Masic More articles by this author , Janet CowanJanet Cowan More articles by this author , Hao NguyenHao Nguyen More articles by this author , Katsuto ShinoharaKatsuto Shinohara More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Whether men with GS 3+4 disease are appropriate active surveillance (AS) candidates remains a matter of debate. We evaluated the effects of the initial Gleason grade on biopsy reclassification, treatment and outcomes after radical prostatectomy (RP). METHODS We followed men on AS between 1990 and 2016. Those diagnosed with Gleason 3+3 or 3+4 were included. Outcomes were biopsy reclassification (increase in Gleason grade =3+4 for those starting with Gleason 3+3 or = 4+3 for those with Gleason 3+4, or volume >33% positive cores), treatment, metastasis, adverse pathology (Gleason =4+3 or stage =pT3a or pN1), and prostate specific antigen (PSA) recurrence after deferred RP. Multivariate Cox proportional hazards regression was used to determine risk factors for outcome events. A sensitivity analysis was performed to evaluate outcomes for patients with limited amount of Gleason 3+4. Models were adjusted for age, PSA, PSA density (PSAD), internal versus external diagnostic biopsy, and percentage of cores positive at diagnosis; PSA recurrence-free survival after surgery was also for pathologic stage and positive surgical margins. RESULTS 1,243 men met inclusion criteria with Gleason 3+3 or 3+4 on initial biopsy. A total of 1,119 (90%) had Gleason 3+3 and 124 (10%) 3+4. Patients with Gleason 3+4 had lower reclassification-free survival (17% vs 39%, p<0.01) and treatment-free survival (49% vs 64%, p<0.01) at 5 years. On multivariate analysis, diagnostic grade was not a risk factor for biopsy reclassification (HR 1.21 95% CI 0.94-1.58), but was a risk factor for treatment (HR 1.37 95% CI 1.01-1.85). Among 367 men who underwent deferred RP, patients with Gleason 3+4 had a higher risk of adverse pathology on univariate analysis (HR 1.96 95% CI 1.25-3.08) but not multivariate analysis (HR 1.32 95% CI 0.80-2.18). At three years, patients starting with Gleason 3+4 had lower unadjusted PSA recurrence-free survival (69% vs 91%, p<0.01); the finding was significant on multivariate analysis (HR 3.67 95% CI 1.30-10.36). A sensitivity model showed that grade was associated with risk of PSA recurrence, however, only for patients with more than one high-grade core. Diagnostic grade was not a risk factor for metastasis on univariate or multivariate analyses. CONCLUSIONS Gleason 3+4 at initial biopsy was a risk factor for treatment and PSA recurrence but was not associated with higher risk of biopsy reclassification, metastasis, or adverse pathology. Sensitivity analysis showed that patients with a single core of Gleason 3+4 at diagnosis have outcomes similar to those with Gleason 3+3. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e135 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Selma Masic More articles by this author Janet Cowan More articles by this author Hao Nguyen More articles by this author Katsuto Shinohara More articles by this author Matthew Cooperberg More articles by this author Peter Carroll More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...