MP20-02 NOVEL RISK STRATIFICATION GROUPING USING STANDARD CLINICAL AND BIOPSY INFORMATION FOR PATIENTS UNDERGOING RADICAL PROSTATECTOMY: RESULTS FROM SEARCH

Abstract

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2017MP20-02 NOVEL RISK STRATIFICATION GROUPING USING STANDARD CLINICAL AND BIOPSY INFORMATION FOR PATIENTS UNDERGOING RADICAL PROSTATECTOMY: RESULTS FROM SEARCH Zachary Zumsteg, Zinan Chen, Lauren Howard, Christopher Amling, William Aronson, Matthew Cooperberg, Christopher Kane, Martha Terris, Daniel Spratt, Howard Sandler, and Stephen Freedland Zachary ZumstegZachary Zumsteg More articles by this author , Zinan ChenZinan Chen More articles by this author , Lauren HowardLauren Howard More articles by this author , Christopher AmlingChristopher Amling More articles by this author , William AronsonWilliam Aronson More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Christopher KaneChristopher Kane More articles by this author , Martha TerrisMartha Terris More articles by this author , Daniel SprattDaniel Spratt More articles by this author , Howard SandlerHoward Sandler More articles by this author , and Stephen FreedlandStephen Freedland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.634AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer is a heterogeneous disease, and risk stratification systems have been proposed to guide treatment decisions and inform patient prognosis. However, significant heterogeneity remains, especially among those with high risk disease, and thus improved stratification is needed. METHODS Data on 3335 men, including 605 high risk, undergoing radical prostatectomy without adjuvant treatment were collected in the SEARCH database. Patients were grouped into five categories: low risk (biopsy Gleason 2-6, T1a-T2a, and PSA <10ng/ml), favorable intermediate risk (FIR), unfavorable intermediate risk (UIR), standard high risk (SHR), very high risk (VHR). Intermediate risk patients by NCCN guidelines (T2b or T2c, biopsy Gleason 7, or PSA 10-20ng/ml) were UIR if they had biopsy Gleason 4+3, ≥50% positive biopsy cores, or multiple intermediate-risk factors (T2b or T2c, biopsy Gleason 7, or PSA 10-20ng/ml), and FIR otherwise. High risk patients by NCCN guidelines (biopsy Gleason score 8-10, T3-T4, or PSA ≥20ng/ml) were VHR if they had primary Gleason 5, >50% positive biopsy cores, T3b-T4 or multiple high-risk factors (biopsy Gleason score 8-10, T3-T4, or PSA ≥20ng/ml), and SHR otherwise. Cox models were used to test the association between risk group and time to biochemical recurrence (BCR) and distant metastases (DM). Competing risks was used to test the association between risk group and prostate cancer-specific mortality (PCSM). Models were adjusted for age, race, year, and surgical center. RESULTS Median follow-up was 78 mo. Men with VHR disease had increased risk of BCR (p<0.001), DM (P=0.004), and PCSM (P=0.011) in comparison to SHR, but there were no differences in BCR, DM, or PCSM between SHR and UIR patients (p>0.4). FIR men had increased risk of BCR (HR 1.34, p=0.006) and DM (HR 2.42, p=0.035) compared to low risk men, but there was no difference in PCSM (p=0.17). Therefore, we propose a novel risk grouping: Group 1 (low risk), Group 2 (FIR), Group 3 (UIR and SHR), and Group 4 (VHR). These groups have markedly different outcomes, with 10 year DM rates of 0.7%, 2.8%, 6.9%, and 16.3% (p<0.001) for Groups 1-4 respectively, and 10 year PCSM of 0.3%, 1.9%, 3.3%, and 10.9% (P<0.001). The c-index of this grouping was 0.80 for DM vs. 0.76 for D'Amico risk groups. CONCLUSIONS Patients classified as VHR have increased rates of PSA relapse, DM, and PCSM in comparison to SHR patients, whereas UIR and SHR patients have similar prognosis. Novel therapeutic strategies are needed for patients with VHR, likely involving multimodality therapy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e239 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zachary Zumsteg More articles by this author Zinan Chen More articles by this author Lauren Howard More articles by this author Christopher Amling More articles by this author William Aronson More articles by this author Matthew Cooperberg More articles by this author Christopher Kane More articles by this author Martha Terris More articles by this author Daniel Spratt More articles by this author Howard Sandler More articles by this author Stephen Freedland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...