MP62-12 CONDITIONAL FREEDOM FROM PROGRESSION ON ACTIVE SURVEILLANCE OF PROSTATE CANCER STRATIFIED BY NCCN RISK

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (MP62)1 Sep 2021MP62-12 CONDITIONAL FREEDOM FROM PROGRESSION ON ACTIVE SURVEILLANCE OF PROSTATE CANCER STRATIFIED BY NCCN RISK Joshua Harvey, Andrew Gusev, Florian Rumpf, Keyan Salari, Jeffrey Twum-Ampofo, Matthew Wszolek, Douglas Dahl, Michael Blute, and Adam Feldman Joshua HarveyJoshua Harvey More articles by this author , Andrew GusevAndrew Gusev More articles by this author , Florian RumpfFlorian Rumpf More articles by this author , Keyan SalariKeyan Salari More articles by this author , Jeffrey Twum-AmpofoJeffrey Twum-Ampofo More articles by this author , Matthew WszolekMatthew Wszolek More articles by this author , Douglas DahlDouglas Dahl More articles by this author , Michael BluteMichael Blute More articles by this author , and Adam FeldmanAdam Feldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002102.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is an accepted strategy for men with very low, low, and select cases of favorable intermediate National Comprehensive Cancer Network (NCCN) risk prostate cancer (PCa). However it is not well defined how the risk of progression evolves during AS. Conditional survival measures the probability a patient will continue to survive some number of years, given that they have already survived a certain number without progression. We evaluated our AS cohort to investigate overall and conditional progression free survival on AS, stratified by the NCCN risk groups. METHODS: We reviewed our institutional database of 1252 men enrolled in AS for localized PCa from 1996-2016. Overall freedom from pathologic grade progression on follow-up biopsy and treatment free survival were estimated using the Kaplan-Meier method. Survival curves were compared pairwise using the Log-rank test and adjusted for false discovery rates with the Benjamini-Hochberg procedure. Three-year conditional survival estimates were derived for both outcomes from the Kaplan-Meier estimator. RESULTS: Of 1252 men, 521 (41.6%) met criteria for very low, 606 (48.4%) for low, and 125 (10.0%) for favorable intermediate NCCN risk at diagnosis. Median follow-up time was 6.5 years (IQR 4.1-9.4). Median pathologic grade progression free survival in years was significantly longer for very low risk (7.8, 95% CI 6.8-11.2) compared to low risk men (5.6, 95% CI 4.7-6.9), however neither was significantly different from favorable intermediate risk men (5.9). There was no significant difference in treatment free survival between the three risk groups. At diagnosis, the three-year risk for pathologic grade progression (24%, 95% CI 21-27%) and progression to treatment (22%, 95% CI 20-25%) were similar. However, with increasing time of event-free AS, the conditional probability of pathologic grade progression increased, while that of progression to treatment decreased. CONCLUSIONS: Our results demonstrate that despite a mild increase in pathologic progression free survival in very low risk men, there was no clear difference in overall treatment free survival between very low, low, and select favorable intermediate NCCN risk men. Further, with increased time spent on AS, despite elevated rates of pathologic progression, patient progression to treatment decreased. This trend may be indicative of changes in goals of care as men with PCa age and should be closely monitored during AS. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1096-e1097 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Harvey More articles by this author Andrew Gusev More articles by this author Florian Rumpf More articles by this author Keyan Salari More articles by this author Jeffrey Twum-Ampofo More articles by this author Matthew Wszolek More articles by this author Douglas Dahl More articles by this author Michael Blute More articles by this author Adam Feldman More articles by this author Expand All Advertisement Loading ...