PD17-06 PSA VELOCITY PREDICTS CLINICAL PROGRESSION IN AFRICAN AMERICAN AND NON-HISPANIC WHITE PATIENTS WITH LOW RISK PROSTATE CANCER UNDERGOING ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD17)1 Sep 2021PD17-06 PSA VELOCITY PREDICTS CLINICAL PROGRESSION IN AFRICAN AMERICAN AND NON-HISPANIC WHITE PATIENTS WITH LOW RISK PROSTATE CANCER UNDERGOING ACTIVE SURVEILLANCE Juan Javier-DesLoges, Tyler Nelson, Rishi Deka, Patrick Courtney, Vinit Nalawade, Loren Mell, James Murphy, J. Kellogg Parsons, and Brent Rose Juan Javier-DesLogesJuan Javier-DesLoges More articles by this author , Tyler NelsonTyler Nelson More articles by this author , Rishi DekaRishi Deka More articles by this author , Patrick CourtneyPatrick Courtney More articles by this author , Vinit NalawadeVinit Nalawade More articles by this author , Loren MellLoren Mell More articles by this author , James MurphyJames Murphy More articles by this author , J. Kellogg ParsonsJ. Kellogg Parsons More articles by this author , and Brent RoseBrent Rose More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001999.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The utility of prostate-specific antigen velocity (PSAV) to predict clinical progression in patients with localized prostate cancer (PC) on active surveillance remains unclear, and in African American (AA) patients on active surveillance remains undefined. METHODS: We performed a cohort analysis using the national US Veterans Affairs Informatics and Computing Infrastructure (VINCI). We identified 5296 patients diagnosed with localized prostate cancer (PC) from 2001 to 2015 managed with active surveillance. Follow-up extended through March 31, 2020. We defined low-risk PC as ISUP grade group 1 (GG1) clinical tumor stage ≤ 2A, and PSA level ≤ 10 ng/dl; and active surveillance as no definitive treatment within the first year after diagnosis with at least one additional staging biopsy after diagnostic biopsy. The primary outcome was grade progression on repeat biopsy/prostatectomy defined as GG2 or GG3. The secondary outcome was incident metastases. Cumulative incidence functions and multivariable Cox proportional hazards models were used to test associations between PSAV and outcomes. RESULTS: The final cohort included 3919 Non-Hispanic White patients (NHW) (74%) and 1377 AA (26%) patients. GG2 progression on repeat biopsy occurred in 2062 (38.9%) patients, with a cumulative incidence (CI) of 43.2 % and GG3 progression occurred in 728 (13.7%) patients, with a CI of 18% at seven years. Fifty-four (0.8%) patients developed metastases, with a CI of 1.4% at ten years. In unadjusted analyses, compared to NHW patients, AA patients were significantly more likely to progress to GG2 (52.8% vs 39.8%, p<0.001), and GG3 (22.2% vs 16.8%, p=0.01). On MV analysis, PSAV was a significant predictor of GG2 (HR 1.32 [1.26-1.39]), GG3 (1.5 [1.40-1.62]), and metastases (1.38 [1.10-1.74]). A significant interaction term between race and PSAV indicated the need for different PSAV thresholds for AA and NHW men. Based on maximally selected rank statistics, optimal thresholds for separating outcomes were different in AA vs NHW men. (0.44 vs. 1.18). CONCLUSIONS: In this analysis of PSAV in low-risk prostate cancer patients on AS—to our knowledge, the largest to date for AA patients—we observed that PSAV is a robust predictor of upgrading on restaging biopsy as well as metastasis. Compared to NHW patients, AA patients were more likely to progress at lower values of PSAV and therefore merit close follow-up on active surveillance protocols. Source of Funding: Department of Defense, grant number W81XWH-17-PCRP-PRA (RD and BSR) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e286-e287 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juan Javier-DesLoges More articles by this author Tyler Nelson More articles by this author Rishi Deka More articles by this author Patrick Courtney More articles by this author Vinit Nalawade More articles by this author Loren Mell More articles by this author James Murphy More articles by this author J. Kellogg Parsons More articles by this author Brent Rose More articles by this author Expand All Advertisement Loading ...