MP15-08 IS PSA DENSITY OR PSA (OR NEITHER) USEFUL TO PREDICT BIOPSY RECLASSIFICATION IN ACTIVE SURVEILLANCE PATIENTS?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2016MP15-08 IS PSA DENSITY OR PSA (OR NEITHER) USEFUL TO PREDICT BIOPSY RECLASSIFICATION IN ACTIVE SURVEILLANCE PATIENTS? Roghayeh Fazeli, Mufaddal Mamawala, Patricia Landis, Sacha Wolf, H. Ballentine Carter, and Bruce J Trock Roghayeh FazeliRoghayeh Fazeli More articles by this author , Mufaddal MamawalaMufaddal Mamawala More articles by this author , Patricia LandisPatricia Landis More articles by this author , Sacha WolfSacha Wolf More articles by this author , H. Ballentine CarterH. Ballentine Carter More articles by this author , and Bruce J TrockBruce J Trock More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2532AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate specific antigen (PSA) and PSA density (PSAD) are widely used to predict risk of biopsy progression in active surveillance (AS) patients. However, their relative prognostic accuracy has not been evaluated, nor has the incremental improvement they provide over other predictors. We compared the predictive accuracy of PSA and PSAD for biopsy reclassification and upgrading in prostate cancer patients managed by AS. METHODS The AS program at Johns Hopkins includes men with clinical stage T1c, PSAD < 0.15 ng/ml/mm3, biopsy Gleason score (GS) =6, <2 positive biopsy cores, =50% core involvement. Older men with low-risk tumors who did not meet all the criteria also entered due to patient preference. Biopsy reclassification is defined by >2 positive cores, >50% core involvement, or GS >7 (upgrading) at annual surveillance biopsy. Cox proportional hazards models of time to biopsy reclassification and upgrading evaluated PSA (PSA =2.5 vs. <2.5) and PSAD (PSAD =0.09 vs. <0.09), adjusted for age, number of positive cores, maximum core involvement, and year of diagnosis. Sub-analyses evaluated whether the effect of PSAD or PSA varied over time (before 2004 vs. 2004 -2014), or by prostate volume (= 45 mm3 vs. <45 mm3), or age at diagnosis (=65 vs. <65). RESULTS 1160 patients (median age 66) with at least 1 surveillance biopsy entered the AS program from 1995-2014. Median follow-up duration, time to reclassification, and time to upgrading were 4.8, 3.3, and 4.2 years, respectively. On multivariable analysis, risk of biopsy reclassification was associated with both binary PSAD, hazard ratio [HR]=1.35 (95% CI 1.1-1.6), p=0.003; and PSA, HR=1.59 (95% CI 1.17-2.15), p=0.003, as was risk of upgrading: PSAD, HR=1.53 (95% CI 1.14-2.06), p=0.004; and PSA, HR=1.71, (95% CI 1.08-2.71), p=0.023. Particularly strong significant associations for both PSAD and PSA were seen in men older than 65 who had prostate volume <45 mm3 (HR=2.40-3.59). However, adding PSA or PSAD to a base model with age, number of positive cores, and maximum tumor percentage gave only small increases in the c-index, except in men with prostate volume <45 (c-index increased from 0.613 to 0.646 for PSA and to 0.648 for PSAD). CONCLUSIONS Both PSAD and PSA have statistically significant predictive value for risks of biopsy reclassification and biopsy upgrading, with neither showing an advantage over the other. However, their utility for risk stratification is particularly important in men older than 65 with prostate volume <45 mm3. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e154-e155 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Roghayeh Fazeli More articles by this author Mufaddal Mamawala More articles by this author Patricia Landis More articles by this author Sacha Wolf More articles by this author H. Ballentine Carter More articles by this author Bruce J Trock More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...