MP46-02 ‘PER-LESION’ BASED ACTIVE SURVEILLANCE IN 502 MEN WITH MEDIAN 4.5 YEARS FOLLOW-UP: IMAGE-BASED MONITORING OF TARGETED BIOPSY-PROVEN PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2014MP46-02 ‘PER-LESION’ BASED ACTIVE SURVEILLANCE IN 502 MEN WITH MEDIAN 4.5 YEARS FOLLOW-UP: IMAGE-BASED MONITORING OF TARGETED BIOPSY-PROVEN PROSTATE CANCER Andre Luis Abreu, Inderbir Gill, Duke Bahn, Sunao Shoji, Arnaud Marien, Jie Cai, Paul Silverman, and Osamu Ukimura Andre Luis AbreuAndre Luis Abreu More articles by this author , Inderbir GillInderbir Gill More articles by this author , Duke BahnDuke Bahn More articles by this author , Sunao ShojiSunao Shoji More articles by this author , Arnaud MarienArnaud Marien More articles by this author , Jie CaiJie Cai More articles by this author , Paul SilvermanPaul Silverman More articles by this author , and Osamu UkimuraOsamu Ukimura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1435AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives We update outcomes of our active surveillance (AS) program in 502 men, with emphasis on image-based monitoring of targeted-biopsy proven cancer and predictors of cross-over to curative intervention (CI). Methods Since 1996, a total of 502 patients underwent AS for low (n=422, 84%) or intermediate (n=80, 16%) risk prostate cancer, with median follow-up of 4.5 years. The AS protocol included PSA (6 monthly), multi-parametric transrectal ultrasound (TRUS) annually, and surveillance biopsy (2-3 yearly, or as indicated). Each dominant hypo-echoic lesion (HEL), confirmed to be cancer on targeted biopsy, was closely monitored, with its dimensions recorded on TRUS annually. Clinical variables were compared between patients remaining on AS versus those crossing over to CI. Primary study end-point was to determine freedom from CI. Results Entry data of patients remaining on AS (n=355; 71%) versus those crossing-over to CI (147; 29%) were similar: age (62 vs. 62yrs, p=0.9), PSA (4.6 vs. 5.2 ng/ml, p=0.06), clinical stage T1c/T2a (318/31 vs. 125/28, p=0.5), biopsy Gleason score [6/7 (3+4)/7(4+3)] of index cancer (317/33/5 vs. 122/23/2, p=0.11), biopsy cancer core length of index cancer (1.3 vs. 2.0 mm, p=0.2) and median dominant HEL dimension (11 vs. 12 mm, p=0.16). On multivariate cox regression, predictors of cross-over to CI included: PSA at entry >4ng/ml (p=0.048), PSA velocity>0.75ng/ml/year (p<0.0001), and any Gleason pattern 4 in biopsy (p=0.0005). Surveillance biopsy outcome predicted cross-over to CI: increase in number of positive cores (p<0.001), Gleason upgrade (p<0.001) and cancer core length ≥4mm (p<0.001). Sequential TRUS monitoring data were as follows: median dominant HEL dimension in patients on AS versus those crossing over to CI were 11 vs. 13mm (p=0.02) at 1-2 years, 11 vs. 13mm (p=0.001) at 3-4 years, and 12 vs. 15mm (p=0.0002) at ≥4 years follow-up, respectively. Estimated probability of CI-free-survival was 78% at 5yrs and 48% at 10 years. Conclusions In a selected cohort of 502 men with low-to-intermediate risk prostate cancer with median 4.5 years follow-up, active surveillance with delayed curative intervention had encouraging outcomes. Image-based monitoring of targeted biopsy-proven cancer can facilitate ‘per-lesion’ based active surveillance strategy. Predictors of cross-over to curative intervention (PSA kinetics, surveillance biopsy outcomes, sequential hypo-echoic lesion size) were identified. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e510 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Andre Luis Abreu More articles by this author Inderbir Gill More articles by this author Duke Bahn More articles by this author Sunao Shoji More articles by this author Arnaud Marien More articles by this author Jie Cai More articles by this author Paul Silverman More articles by this author Osamu Ukimura More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...