MP42-01 NO SIGNIFICANT IMPROVEMENT IN PATIENT OUTCOMES WHEN STRICTER ACTIVE SURVEILLANCE CRITERIA ARE APPLIED: A COMPARISON OF CONTEMPORARY ACTIVE SURVEILLANCE PROTOCOLS

Abstract

INTRODUCTION AND OBJECTIVES: Activesurveillance (AS) is of growing interest as an alternative to radical treatment of low-risk prostate cancer (PCa). However various surveillance eligibility criteria and protocols exist with no consensus among stakeholders as to which criteria and protocol yield the best results for the most patients. Our aim is to discern between the outcomes of stricter versus more inclusive AS protocols and elucidatewhether oneprovidesmore favorable outcomes formost patients. METHODS: Between 1998-2014, 912 men enrolled in an AS program at Princess Margaret Cancer Centre (PM) between, with the following inclusioncriteria:PSA 10, clinical stage cT2,Gleasonsum 6, number of positive cores 3, no single core>50% involved, age 75 years. All patients who met the set criteria were retrospectively reviewed and assessed for entry eligibility into: Prostate Cancer Research International: Active Surveillance (PRIAS), John Hopkins Medical Institute (JH), University of Miami (UM), University of California, San Francisco (UCSF), Memorial Sloan-Kettering Cancer Center (MSK) and University of Toronto (UT).We also considered how the use of the various protocols would alter the timing and utilization of curative intervention. Univariate and multivariate statistics with Cox proportional hazards were used for comparisons. Logistic regression was used to determine any significant associations. All statistical analysis was done using SAS . RESULTS: From 912 men enrolled over the 16 year period, 712 met PM inclusion criteria. When JH, PRIAS, and UM criteria were applied to these patients 13.7%, 11.5%, and 8.8% of these men were excluded from AS. However, when we compared outcomes such as grade or volume progression there were no significant differences between men who met the PM criteria and those who met stricter AS criteria. No significant differences in PSA velocity, or the number of patient who proceeded to seek treatment (p>0.1). Time to treatment and follow-up were also not significantly different between men who were followed on a more inclusive versus more exclusive AS protocols. CONCLUSIONS: While there are differences in inclusion criteria for AS, our results demonstrate that more strict criteria do not significantly improve patient outcomes when considering relative risk of Gleason Score upgrading, or biochemical failure after treatment. In an era of heightened awareness regarding over-diagnosis and overtreatment of prostate cancer, we believe that these stricter entry criteria should be reconsidered.