MP78-02 RELATIONSHIP BETWEEN THE CONTINUITY AND DISCONTINUITY OF TWO POSITIVE CORES IN PROSTATE BIOPSY SPECIMENS FOR THE PREDICTION OF LOW-RISK PROSTATE CANCER AND IDENTIFICATION OF CANDIDATES FOR ACTIVE SURVEILLANCE

Abstract

INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is increasingly recognized as the recommended treatment option in prostate cancer (PCa) patients with clinically localized, low-risk disease. However, previous studies suggest that its utilization is uncommon.Weset to evaluate the nationwide utilization rate of AS in the contemporary era, identifying predictors of local treatment of the prostate in AS candidates. METHODS: We relied on the 2010e2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9,049 patients that fulfilled the University of California, San Francisco (UCSF) AS criteria: prostate-specific antigen (PSA) <10ng/ ml, biopsy Gleason score 6 with no pattern 4 or 5, clinical stage T1/T2a, and percentage of positive cores <33%. The main outcome was local treatment of PCa, defined as receiving radical prostatectomy, external beam radiation therapy, or brachytherapy. Logistic regression analysis tested the relationship between receiving local treatment and all available predictors, which consisted of age, race (White vs. African American vs. Hispanic vs. Other), marital status (not married vs. married), annual family income, insurance status (uninsured vs. Medicaid covered vs. insured), total PSA, clinical stage (T1 vs. T2a), and percentage of positive cores. RESULTS: Overall, 6,130 patients (68%) received local treatment of PCa. At multivariable analysis, married patients (odds ratio [OR]: 1.63; 95% confidence interval [CI]: 1.46, 1.82; p<0.0001), insured patients (OR: 1.71; 95% CI: 1.10, 2.66; p1⁄40.016), clinical stage cT2a (OR: 1.23; 95%CI: 1.01, 1.49; p1⁄40.037), and percentage of positive cores (OR per2%:1.09; 95%CI: 1.08, 1.11; p<0.0001)weresignificantly associated with higher probability of receiving local treatment of PCa. In contrast, patient age (OR: 0.90; 95% CI: 0.89, 0.91; p<0.0001) was inversely correlated with receiving local treatment of PCa. Differently, African American (OR: 0.91; 95% CI: 0.79, 1.05; p1⁄40.2) and Hispanic patients (OR: 0.90; 95% CI: 0.76, 1.06; p1⁄40.2) did not have significantly different probability of receiving local treatment when compared toWhite patients. CONCLUSIONS: In the United States, a considerable proportion of patients suitable for AS receive local treatment of the prostate. More extensive and palpable diseases, as well as having a medical insurance, are associated with increased probability of receiving local treatment. Conversely, racial disparities in the management of contemporary AS candidates were not observed.