OP3-04 DETECTION AND UPGRADING OF PROSTATE CANCER BY MRI/ULTRASOUND FUSION GUIDED BIOPSY ACROSS PSA-BASED CUTOFFS

Abstract

INTRODUCTION AND OBJECTIVES: Active surveillance (AS) is a treatment strategy for prostate cancer (CaP) involving close monitoring of men diagnosed with low-risk CaP to reduce overtreatment. We report here factors associated with disease progression while on AS in a large, single institution cohort. METHODS: We retrospectively reviewed the data of men enrolled in the University of California at San Francisco (UCSF) AS cohort between 1990 and 2012. Strict eligibility criteria were prostatespecific antigen (PSA) 33% cores. Factors associated with progression while on active surveillance were determined through multivariate Cox proportional hazards regression. RESULTS: Of 1,106 men enrolled in AS at UCSF, 764 men have consented to participate in research to date and have been followed on AS for a median of 57 months. Of these, 520 (68%) met strict criteria for AS while 244 (32%) did not. The median number of repeat biopsies was 3 (IQR 2-4). At 5 years after diagnosis, 53 % were progression-free and 40% of patients received local therapy. Overall survival was 94% among those not AS eligible and 99% among those AS eligible at 5 years. There were no CaP-related deaths. In multivariate analysis, PSA density (PSAD), total number of biopsies, and later year of diagnosis were positively associated with the risk of both biopsy progression (HR (95% CI): 1.58 (1.33-1.88); 0.82 (0.72-0.94); 1.17 (1.11-1.25) , respectively) and receiving treatment (HR (95%CI): 1.39 (1.20-1.61); 0.71 (0.64-0.78); 1.20 (1.15-1.25), respectively), all p<0.01. CONCLUSIONS: The majority of men who enrolled in this active surveillance cohort remained on AS after a median follow up of 57 months. While higher PSAD was associated with biopsy progression, additional predictive tools would improve selection and counseling of men for AS.