PD62-01 A FIRST STEP TOWARDS A GLOBAL NOMOGRAM TO PREDICT DISEASE PROGRESSION FOR MEN ON ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD62)1 Apr 2020PD62-01 A FIRST STEP TOWARDS A GLOBAL NOMOGRAM TO PREDICT DISEASE PROGRESSION FOR MEN ON ACTIVE SURVEILLANCE Mieke Van Hemelrijck, Xinge Ji, Jozien Helleman, Monique Roobol*, Daan Nieboer, Chris Bangma, Mark Frydenberg, Antti Rannikko, Lui Shiong Lee, Vincent Gnanapragasam, Mike Kattan, and GAP3 Movember Foundation's Active Surveillance Database Mieke Van HemelrijckMieke Van Hemelrijck More articles by this author , Xinge JiXinge Ji More articles by this author , Jozien HellemanJozien Helleman More articles by this author , Monique Roobol*Monique Roobol* More articles by this author , Daan NieboerDaan Nieboer More articles by this author , Chris BangmaChris Bangma More articles by this author , Mark FrydenbergMark Frydenberg More articles by this author , Antti RannikkoAntti Rannikko More articles by this author , Lui Shiong LeeLui Shiong Lee More articles by this author , Vincent GnanapragasamVincent Gnanapragasam More articles by this author , Mike KattanMike Kattan More articles by this author , and GAP3 Movember Foundation's Active Surveillance Database GAP3 Movember Foundation's Active Surveillance Database More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000979.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Using data from Movembers’ GAP3 Consortium we have shown that after 5 yrs of follow-up, 57% of men who started on active surveillance (AS) were still on AS. Signs of disease progression (28%) and conversion to active treatment without evidence of disease progression (13%) were the main reasons for discontinuation. We aimed to develop a nomogram to be used as a prediction tool for outcomes in men with localised prostate cancer (PCa) on AS. METHODS: As a first step in the development of a nomogram, we assessed heterogeneity between centres in terms of discontinuation due to disease progression. We started with the assessment of the baseline hazards for disease progression based on grouping of GAP3 centres according to similarities in follow-up protocols [high: yearly; intermediate: ∼2 yearly; and low: at year 1, 4 & 7 (i.e. PRIAS)]. We conducted cause-specific Cox proportional hazards regression to estimate the risk of disease progression by centre in each group. We then evaluated heterogeneity of prevalence of clinical factors and their relationship to disease progression with univariate and multivariate hazard ratios by centre. RESULTS: 14,380 men were included. Heterogeneity analysis for the risk of disease progression showed large differences in risk of upgrading between centres (median HR: 2.5). Next, we assessed how clinical factors such as age (</≥70 years), year of diagnosis (</≥2010), Gleason grade group (</≥2), number of positive cores (</≥2), and PSA (</≥7 ng/mL) were predictors of disease progression for each centre. After adjustment for these clinical factors, the heterogeneity in risk of disease progression remained between the centres (Figure 1). CONCLUSIONS: When combining worldwide cohorts of men on AS, we noted unexplained differences in baseline hazards of disease progression. However, the relative effects of patient characteristics on risk of disease progression were fairly stable between centres. This indicates that it is possible to develop a global nomogram in future, provided that local adjustments for differences in risk of disease progression and competing risks (e.g. watchful waiting, conversion to active treatment, or death) are taken into account for these observed differences in baseline hazards or reasons for these differences are examined further. Source of Funding: Movember Foundation. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1285-e1285 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mieke Van Hemelrijck More articles by this author Xinge Ji More articles by this author Jozien Helleman More articles by this author Monique Roobol* More articles by this author Daan Nieboer More articles by this author Chris Bangma More articles by this author Mark Frydenberg More articles by this author Antti Rannikko More articles by this author Lui Shiong Lee More articles by this author Vincent Gnanapragasam More articles by this author Mike Kattan More articles by this author GAP3 Movember Foundation's Active Surveillance Database More articles by this author Expand All Advertisement PDF downloadLoading ...