PD30-03 PREDICTING UNFAVORABLE PROSTATE CANCER IN ACTIVE SURVEILLANCE CANDIDATES TREATED WITH RADICAL PROSTATECTOMY: A POPULATION-BASED STUDY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2015PD30-03 PREDICTING UNFAVORABLE PROSTATE CANCER IN ACTIVE SURVEILLANCE CANDIDATES TREATED WITH RADICAL PROSTATECTOMY: A POPULATION-BASED STUDY Nicola Fossati, Justin K. Lee, Quoc-Dien Trinh, Jesse Sammon, Akshay Sood, Alessandro Larcher, Marco Bianchi, Giorgio Guazzoni, Pierre I. Karakiewicz, Shahrokh F. Shariat, Francesco Montorsi, Alberto Briganti, Mani Menon, and Firas Abdollah Nicola FossatiNicola Fossati More articles by this author , Justin K. LeeJustin K. Lee More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Jesse SammonJesse Sammon More articles by this author , Akshay SoodAkshay Sood More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Mani MenonMani Menon More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1824AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Most current guidelines recommend active surveillance (AS) as a valid treatment option for clinically localized, low-risk prostate cancer (PCa) to reduce overtreatment. However, a considerable proportion of AS candidates harbors unfavorable PCa at final pathology when surgically treated. The aim of this study was to identify predictors of unfavorable PCa in AS candidates that were treated surgically. METHODS We relied on the 2010–2011 Surveillance Epidemiology and End Results (SEER) database. We identified 3,300 patients treated with radical prostatectomy who could have been selected for AS according to the UCSF criteria: prostate-specific antigen (PSA) <10 ng/ml, biopsy Gleason score ≤6 with no pattern 4 or 5, clinical stage T1/T2a, and percentage of positive cores <33%. All patients had complete demographic, clinical, and pathologic data. The main outcome was unfavorable PCa, defined as pathologic Gleason score ≥4+3 and/or pathologic stage ≥pT3b. We performed a sensitivity analysis defining unfavorable PCa as pathologic Gleason score ≥7 and/or pathologic stage ≥pT3a. Multivariable logistic regression analysis tested the relationship between unfavorable PCa and age, race (White vs African American vs Hispanic vs Other), marital status (not married vs married), annual family income, insurance status (insured vs Medicaid covered vs uninsured), total PSA, clinical stage (T1 vs T2a), and percentage of positive cores. RESULTS Overall, 195 patients (5.9%) harbored unfavorable PCa at final pathology. On the other hand, 1,309 patients (40%) showed unfavorable PCa when pathologic Gleason score ≥7 and/or pathologic stage ≥pT3a were considered. At multivariable analysis, patient age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01, 1.05; p=0.006), African American patients (OR: 1.82; 95% CI: 1.19, 2.78; p=0.016), Hispanic patients (OR: 1.63; 95% CI: 1.04, 2.57; p=0.033), and total PSA (OR: 1.15; 95% CI: 1.07, 1.25; p<0.0004) were significantly associated with higher probability of harboring unfavorable PCa. These results were confirmed when unfavorable PCa was defined as pathologic Gleason score ≥7 and/or pathologic stage ≥pT3a. CONCLUSIONS A significant proportion of AS candidates harbors unfavorable PCa at final pathology, even considering stringent criteria as adverse cancer features (namely, pathologic Gleason ≥4+3 or pathologic stage ≥pT3b). Patient age, race, and total PSA are significant predictors of unfavorable PCa. These results should be taken into account when counseling AS candidates. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e655 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicola Fossati More articles by this author Justin K. Lee More articles by this author Quoc-Dien Trinh More articles by this author Jesse Sammon More articles by this author Akshay Sood More articles by this author Alessandro Larcher More articles by this author Marco Bianchi More articles by this author Giorgio Guazzoni More articles by this author Pierre I. Karakiewicz More articles by this author Shahrokh F. Shariat More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Mani Menon More articles by this author Firas Abdollah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...