PD20-05 RISK OF MEN WITH INTERMEDIATE RISK PROSTATE CANCER GOING ONTO DEFINITIVE TREATMENT DURING ACTIVE SURVEILLANCE; DOES A HIGH PSA PREDICT A WORSE OUTCOME?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2018PD20-05 RISK OF MEN WITH INTERMEDIATE RISK PROSTATE CANCER GOING ONTO DEFINITIVE TREATMENT DURING ACTIVE SURVEILLANCE; DOES A HIGH PSA PREDICT A WORSE OUTCOME? John Burns, Lauren Hurwitz, Katherine Levie, Fernando Caumont, Timothy Brand, Inger Rosner, Sean Stroup, Joseph Sterbis, Jennifer Cullen, and Christopher Porter John BurnsJohn Burns More articles by this author , Lauren HurwitzLauren Hurwitz More articles by this author , Katherine LevieKatherine Levie More articles by this author , Fernando CaumontFernando Caumont More articles by this author , Timothy BrandTimothy Brand More articles by this author , Inger RosnerInger Rosner More articles by this author , Sean StroupSean Stroup More articles by this author , Joseph SterbisJoseph Sterbis More articles by this author , Jennifer CullenJennifer Cullen More articles by this author , and Christopher PorterChristopher Porter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1009AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Management of patients with intermediate risk (IR) prostate cancer (PCa) based on PSA elevation but with Gleason 3+3 disease remains elusive; some authors have suggested that many could be offered active surveillance (AS). This study evaluated time to definitive treatment (DT) for PCa patients with IR (defined by PSA alone), low risk (LR) and favorable intermediate-risk (FIR) patients. METHODS A retrospective cohort study was performed from the Center for Prostate Disease Research (CPDR) multi-center national database between 1989-2013. Men ≤75 y/o with ≤ cT2a, Gleason ≤ 3+4 PCa, and PSA < 20, were included. We stratified patients into LR (defined by NCCN criteria), FIR (defined as Gleason ≤ 3+4, PSA <10) and IR PCa (defined by NCCN LR criteria, except PSA 10-20). The study population was restricted to men on AS, defined as men who received no definitive treatments in the first 12 months following diagnosis. The primary outcome was progression to DT among patients on AS. Time to DT was compared between the three comparison groups using Kaplan-Meier survival curves and the log-rank test. RESULTS Of 4,244 eligible men, there were 3,005 LR, 337 IR, and 902 FIR patients. Management on AS in the CPDR cohort was 16.1%, 10.6%, and 7.9% for LR, IR, and FIR respectively. Age at diagnosis was similar: 64.1 for LR, 65.7 for IR, and 63.3 years for FIR. Over one-quarter of patients were African American. PSA at diagnosis was 4.4 for LR, 13.7 for IR, and 5.5 for FIR patients. Median time to DT was 20.0, 17.2, and 20.6 months, for each risk group respectively. In patients undergoing initial AS, 23.3% LR, 25% IR, 36.6% FIR went on to DT during follow up; importantly, there were no significant differences between groups (Fig 1), p = 0.08. CONCLUSIONS In this large racially diverse, prospectively collected DB, AS remains underutilized in patients with low risk and intermediate risk disease. Patients with PSA defined IR disease who undergo AS progress to DT at similar rates as LR and FIR patients, and should be considered candidates for AS. We recognize long term follow up is needed to evaluate cancer progression in this cohort. Current efforts are underway to monitor trends in AS in recent years, as overtreatment rates continue to decrease. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e403 Advertisement Copyright & Permissions© 2018MetricsAuthor Information John Burns More articles by this author Lauren Hurwitz More articles by this author Katherine Levie More articles by this author Fernando Caumont More articles by this author Timothy Brand More articles by this author Inger Rosner More articles by this author Sean Stroup More articles by this author Joseph Sterbis More articles by this author Jennifer Cullen More articles by this author Christopher Porter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...