PD62-08 PREDICTED RISK OF PROSTATE CANCER-SPECIFIC MORTALITY ON ACTIVE SURVEILLANCE FOR MEN WITH FAVORABLE INTERMEDIATE RISK PROSTATE CANCER: RESULTS FROM THE SEARCH DATABASE

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You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD62)1 Apr 2020PD62-08 PREDICTED RISK OF PROSTATE CANCER-SPECIFIC MORTALITY ON ACTIVE SURVEILLANCE FOR MEN WITH FAVORABLE INTERMEDIATE RISK PROSTATE CANCER: RESULTS FROM THE SEARCH DATABASE Paige K. Kuhlmann, MD* Taofik Oyekunle, Lauren E. Howard, MS Zachary Klaassen, MD MSc Christopher L. Amling, MD William J. Aronson, MD Matthew R. Cooperberg, MD MPH Christopher J. Kane, MD Martha K. Terris, and Stephen J. FreedlandMD Paige K. KuhlmannPaige K. Kuhlmann More articles by this author , Taofik OyekunleTaofik Oyekunle More articles by this author , Lauren E. HowardLauren E. Howard More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Christopher L. AmlingChristopher L. Amling More articles by this author , William J. AronsonWilliam J. Aronson More articles by this author , Matthew R. CooperbergMatthew R. Cooperberg More articles by this author , Christopher J. KaneChristopher J. Kane More articles by this author , Martha K. TerrisMartha K. Terris More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000979.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Limited data exist to help surgeons decide between active surveillance (AS) vs. treatment for men with favorable intermediate risk (FIR) prostate cancer (PC). Ten-year results from a large randomized controlled trial (ProtecT) including men with low risk and FIR disease on AS versus treatment reported a non-significant 1.7 fold increase in PC-specific mortality (PCSM) for AS, though most men were low risk. To determine the excess risk of PCSM with AS vs. radical prostatectomy (RP), we determined the risk of PCSM in FIR men undergoing RP and estimated the PCSM risk for AS using a range of increased PSCM scenarios ranging from 50% higher to 5-fold higher. METHODS: We retrospectively reviewed data from men undergoing RP from 1988-2017 at 8 Veterans Affairs hospitals within the SEARCH Database. Men with FIR PC were identified using the NCCN risk criteria (<50% positive biopsy cores & cT2b-c or grade group (GG) 2 or PSA 10-20). Risk of PCSM at 5, 10, and 15 years after RP was estimated. Using these estimates, PCSM and number needed to harm (NNH) at 5, 10, and 15 years was then estimated for AS using a range of increased risk of PCSM relative to RP ranging from 50% higher to 5-fold higher. RESULTS: For the 920 FIR men identified, 5-, 10-, and 15-year survival estimates for PCSM were 99.86%, 99.01%, and 97.63%, respectively. Using these estimates, if the risk of PCSM on AS were 1.5 times greater than RP, for 15 year survival 92 patients would need to be put on AS for 1 excess PC-specific death to occur (1.09% excess risk of PCSM). If the risk of PCSM on AS were 5 times greater than RP, for 15 year survival the NNH would be 12 (8.68% excess risk of PCSM). Tables 1a&b summarize NNH and risk of excess PCSM assuming AS has 1.5, 2, 3, and 5 times the risk of PCSM relative to RP. CONCLUSIONS: The risk of death for FIR after RP is very low. Assuming even modest increases PCSM with AS vs. RP, the excess risk of death for AS in FIR is low. These data support the consideration of AS as a relatively safe alternative to RP in FIR men, though prospective randomized trials are needed to validate these findings. Source of Funding: n/a © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1289-e1289 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paige K. Kuhlmann More articles by this author Taofik Oyekunle More articles by this author Lauren E. Howard More articles by this author Zachary Klaassen More articles by this author Christopher L. Amling More articles by this author William J. Aronson More articles by this author Matthew R. Cooperberg More articles by this author Christopher J. Kane More articles by this author Martha K. Terris More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...