MP79-12 KI-67 PROLIFERATION ON PROSTATE BIOPSY IS ASSOCIATED WITH UNFAVORABLE PATHOLOGY AT PROSTATECTOMY AND BIOCHEMICAL RECURRENCE AMONG LOW RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 2014MP79-12 KI-67 PROLIFERATION ON PROSTATE BIOPSY IS ASSOCIATED WITH UNFAVORABLE PATHOLOGY AT PROSTATECTOMY AND BIOCHEMICAL RECURRENCE AMONG LOW RISK PROSTATE CANCER John Knoedler, Karnes R. Jeffrey, Boyd Viers, Laureano Rangel, Eric Bergstralh, and Matthew Tollefson John KnoedlerJohn Knoedler More articles by this author , Karnes R. JeffreyKarnes R. Jeffrey More articles by this author , Boyd ViersBoyd Viers More articles by this author , Laureano RangelLaureano Rangel More articles by this author , Eric BergstralhEric Bergstralh More articles by this author , and Matthew TollefsonMatthew Tollefson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2515AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance is a management option for patients with localized prostate cancer. However, even with rigorous selection criteria (Gleason 6, PSA <10 ng/ml, clinical stage ≤pT2a), certain patients progress while on surveillance. Therefore, additional tools are needed to improve prediction of cancer outcomes. Herein, we evaluate the association of Ki-67 proliferation index with pathologic upstaging/upgrading at radical prostatectomy (RP) and its association with biochemical recurrence among patients with low-risk prostate cancer. METHODS Since 1993, our institution has performed assessment of cellular proliferation (Ki-67) on all prostate cancer biopsies. We identified 809 patients who met NCCN criteria for low-risk disease (Gleason≤6, PSA <10, clinical stage ≤T2a) and underwent both biopsy and radical prostatectomy at our institution. Ki-67 proliferation was assessed by the nuclear antibody MIB-1 and reported as a percent positive. Clinicopathologic data were correlated to Ki-67 proliferation. Kaplan-Meier analysis estimated survival, and multivariable Cox proportional hazard regression models evaluated the association of Ki-67 with upstaging/upgrading at prostatectomy and biochemical recurrence. RESULTS Among 809 patients 126 (15.6%) had Ki-67 expression >5%, while 683 (84.4%) had expression ≤5%. Median follow up was 10.4 years after surgery. Overall 131 patients (16.2%) experienced biochemical recurrence, 15 (1.9%) experienced systemic progression, and 6 (0.7%) died from prostate cancer. Patients with a biopsy Ki-67 proliferation >5% were significantly more likely to be upstaged/upgraded at surgery (pathologic Gleason ≥7, stage ≥pT3, or N+) compared to patients with proliferation ≤5% (35.7% vs 18.2%; p<0.0001). On multivariate analysis. Ki-67 proliferation (as a continuous variable) was significantly associated with upstaging at RP (HR 1.14; p<0.0001), as well as biochemical recurrence (HR 1.07; p= 0.04). CONCLUSIONS Among patients with low-risk prostate cancer, Ki-67 proliferation is predictive of unfavorable pathology at RP as well as biochemical recurrence after RP. In fact, for each percent increase in Ki-67 index there was a 14% increase risk of upstaging/upgrading. Given its low cost and wide availability, Ki-67 is a biomarker that may help stratify and counsel patients with low-risk prostate cancer considering treatment options. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e934 Advertisement Copyright & Permissions© 2014MetricsAuthor Information John Knoedler More articles by this author Karnes R. Jeffrey More articles by this author Boyd Viers More articles by this author Laureano Rangel More articles by this author Eric Bergstralh More articles by this author Matthew Tollefson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...