PD62-10 ASSESSING FOCALITY OF DOMINANT TUMOR ON SERIAL BIOPSY IN AN ACTIVE SURVEILLANCE COHORT - IMPLICATIONS FOR FOCAL THERAPY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD62)1 Apr 2020PD62-10 ASSESSING FOCALITY OF DOMINANT TUMOR ON SERIAL BIOPSY IN AN ACTIVE SURVEILLANCE COHORT - IMPLICATIONS FOR FOCAL THERAPY Vittorio Fasulo*, Janet E. Cowan, Samuel L. Washington, Hao G. Nguyen, Katsuto Shinohara, Paolo Casale, and Peter R. Carroll Vittorio Fasulo*Vittorio Fasulo* More articles by this author , Janet E. CowanJanet E. Cowan More articles by this author , Samuel L. WashingtonSamuel L. Washington More articles by this author , Hao G. NguyenHao G. Nguyen More articles by this author , Katsuto ShinoharaKatsuto Shinohara More articles by this author , Paolo CasalePaolo Casale More articles by this author , and Peter R. CarrollPeter R. Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000979.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy (FT) has been proposed as an alternative to active surveillance (AS) for men with low/intermediate risk prostate cancer (PCa). We aim to understand progression within and outside the dominant tumor (DT) in terms of changes in focality, tumor volume and histologic grading on serial biopsy of the prostate (Bx) to identify reasonable candidates for FT. METHODS: Men enrolled on AS at UCSF between 1996 and 2017 with low\intermediate risk PCa at diagnosis (PSA < 20ng\ml, clinical stage T1\2, Gleason score (GS) 3+3\3+4), at least 10 biopsy cores taken at diagnosis, and at least 1 biopsy after diagnosis were included. All biopsies were systematic biopsy. Changes in biopsy laterality and/or grade over time were assessed. DT was defined as the tumor with highest GS and size on biopsy confined to 1 or 2 contiguous sextants. Those with unifocal disease (Un), multifocal in contiguous sextants (Mc), or a small volume of GS 3+3 on the contralateral side were considered candidates for FT. RESULTS: Among 1272 men, mean patient age was 62 years and median PSA was 5.42 ng\ml. Median follow up was 78 months (IQR 46-108). Median number of biopsies was 3 (min 2, max 12) and 18% had 5 Bx or more. At diagnosis 1142 (90%) and 130 (10%) patients had GS 3+3 and GS 3+4 disease respectively. At first surveillance Bx (fsBX) findings were negative in 255 (20%), unchanged in 711 (56%), and upgraded in 306 (24%). Proportions of findings were similar at the following 3 biopsies. Across all biopsies 27% were negative and 7-year upgrade-free survival was 39%. At diagnosis, 88% of tumors were in locations viable for FT (50% Un and 38% Mc versus 12% multifocal in non-contiguous sextants (Mn-c)). At fsBX, 21% of biopsies were negative and 85% of the remainder were viable for FT (29% Un and 56% Mc versus 15% Mn-c). Across all biopsies DT remained stable in 592 (47%), changed prostate side or expanded to bilateral in 128 (10%), upgraded on the original dominant side in 407 (32%), and upgraded on the opposite side in 145 (11%). Of those upgraded on the non-dominant side, 74% were GS 3+4, 21% were GS 4+3 and 5% were GS≥4+4. CONCLUSIONS: Findings on serial biopsy in men with low risk disease on AS suggest that tumor location remains relatively stable and that significant changes in grade and/or volume occur in the dominant tumor focus. A low percentage of patients show significant progression outside the dominant tumor. Such information is relevant when considering FT in this patient population. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1290-e1290 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vittorio Fasulo* More articles by this author Janet E. Cowan More articles by this author Samuel L. Washington More articles by this author Hao G. Nguyen More articles by this author Katsuto Shinohara More articles by this author Paolo Casale More articles by this author Peter R. Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...