PD55-07 VERY LOW RISK AND LOW RISK PATIENTS IN ACTIVE SURVEILLANCE: IS THE DISTINCTION RELEVANT?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance III1 Apr 2017PD55-07 VERY LOW RISK AND LOW RISK PATIENTS IN ACTIVE SURVEILLANCE: IS THE DISTINCTION RELEVANT? R. Yates Coley, Scott Zeger, Mufaddal Mamawala, and H. Ballentine Carter R. Yates ColeyR. Yates Coley More articles by this author , Scott ZegerScott Zeger More articles by this author , Mufaddal MamawalaMufaddal Mamawala More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2430AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active Surveillance (AS) of localized prostate cancer (PCA) has been shown to be a safe alternative to immediate curative treatment for men with favorable risk diagnoses; very low risk (VLR) and low risk (LR). The relevance of stratifying patients into VLR and LR categories for the purposes of enrollment and analysis is in question. Our objective was to compare the difference in cancer risk for men with VLR and LR disease. METHODS We used the clinical data from 1,032 VLR and 446 LR patients enrolled in the Johns Hopkins prospective AS program to predict the pathologic Gleason score (PGS) as the outcome of interest. Predictions were obtained by extending a statistical model developed in the VLR cohort (SITE PUBLICATION HERE), to estimate different probability distributions of PGS between VLR and LR groups. This approach leverages 1) repeated PSA and biopsy measurements taken in the course of AS, 2) post-prostatectomy PGS findings in AS patients to identify patterns of clinical measurements associated with more aggressive pathology. The model is agnostic with regard to differential risk a priori (i.e., biopsy extent of cancer). RESULTS LR patients were significantly more likely than VLR patients to have a PGS above 6 (p<0.01). The estimated probability of PGS=6 for VLR and LR patients was 71% and 57%, respectively (Table). Both VLR and LR patients were unlikely to have predicted PGS of >4+3; 9.2% and 10%, respectively. CONCLUSIONS As compared to VLR, men with LR PCA were more likely to harbor pathologically significant disease, suggesting that this distinction is clinically relevant. Long term cancer specific outcomes will be necessary to confirm the clinical significance of these findings. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1053 Advertisement Copyright & Permissions© 2017MetricsAuthor Information R. Yates Coley More articles by this author Scott Zeger More articles by this author Mufaddal Mamawala More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...