MP38-03 DOES PROSTATE CANCER FAMILY HISTORY HAVE AN IMPACT ON ACTIVE SURVEILLANCE ADHERENCE IN MEN WITH LOW- OR FAVOURABLE INTERMEDIATE RISK DISEASE?

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP38-03 DOES PROSTATE CANCER FAMILY HISTORY HAVE AN IMPACT ON ACTIVE SURVEILLANCE ADHERENCE IN MEN WITH LOW- OR FAVOURABLE INTERMEDIATE RISK DISEASE? Riccardo Leni, Armando Stabile, Giorgio Gandaglia, Vito Cucchiara, Marco Bandini, Elio Mazzone, Leonardo Quarta, Paolo Zaurito, Francesco De Cobelli, Giorgio Brembilla, Nicola Fossati, Lugano, Switzerland, Emanuele Zaffuto, Marco Moschini, Giulio Avesani, Federico Dehò, Francesco Montorsi, and Alberto Briganti Riccardo LeniRiccardo Leni More articles by this author , Armando StabileArmando Stabile More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Marco BandiniMarco Bandini More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Leonardo QuartaLeonardo Quarta More articles by this author , Paolo ZauritoPaolo Zaurito More articles by this author , Francesco De CobelliFrancesco De Cobelli More articles by this author , Giorgio BrembillaGiorgio Brembilla More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Lugano Lugano More articles by this author , Switzerland Switzerland More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Giulio AvesaniGiulio Avesani More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with family history (FH) of prostate cancer (PCa) on active surveillance (AS) for low grade PCa are at higher risk of reclassification. In these patients, however, adherence to AS may be influenced by factors other than reclassification. We assessed the relationship between FH and AS drop-out without evidence of reclassification compared to patients without FH. METHODS: We identified 779 men on AS for grade group 1 or 2 PCa at our Institution (2005-2021). Reclassification was defined as an increase in Gleason score from diagnosis. The cumulative incidence function estimated the 5-year discontinuation rate without reclassification according to FH (any-degree, vs no FH), with discontinuation for reclassification as a competing event. The Fine and Gray model was used to derive the adjusted sub-distribution hazard ratios (aSHR). A sensitivity analysis was conducted incorporating a definition of volume reclassification (>33% of cores involved or >50% of a single core involved), and the NCCN definition of strong FH (≥1 first-degree or ≥2 second-degree relatives). To assess clinical utility, we evaluated rates of adverse pathology ([AP], grade group ≥2, extracapsular extension, or positive lymph nodes) in 246 men who underwent delayed radical prostatectomy (RP) according to the reason for discontinuation. RESULTS: Median age was 65 years (59-70 yrs), 135 men (18%) had FH, and 112 (14%) had strong FH. Median follow-up was 50 months, the overall 5-year reclassification rate was 42%. The overall 5-year rate of discontinuation without reclassification was 23% (n=118). The cumulative incidence of 5-year discontinuation without reclassification in patients with, vs without FH was 27% vs 15% (aSHR 1.61, p=0.029). The effect of FH on discontinuation without reclassification remained significant in all sensitivity analyses. No difference was observed in terms of AP at delayed RP according to FH in those reclassified vs those treated without reclassification (all p>0.05). CONCLUSIONS: Although FH is associated with higher risk of reclassification, almost a third of men with positive FH discontinue AS without evidence of progression. The absence of a difference in AP rates at delayed RP should guide patient counseling about safety of AS also in men with FH. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e524 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Leni More articles by this author Armando Stabile More articles by this author Giorgio Gandaglia More articles by this author Vito Cucchiara More articles by this author Marco Bandini More articles by this author Elio Mazzone More articles by this author Leonardo Quarta More articles by this author Paolo Zaurito More articles by this author Francesco De Cobelli More articles by this author Giorgio Brembilla More articles by this author Nicola Fossati More articles by this author Lugano More articles by this author Switzerland More articles by this author Emanuele Zaffuto More articles by this author Marco Moschini More articles by this author Giulio Avesani More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...