Presentation Authors: Andrew M Wood*, New Hyde Park, NY, Daniel Rabinowitz, Brooklyn, NY, Allison Marziliano, Andre Perez-Orozco, New Hyde Park, NY, Srinath Kotamarti, Alyssa Yee, Brooklyn, NY, Luke Griffiths, Michael Diefenbach, Manish Vira, Simon J Hall, New Hyde Park, NY
Introduction: Active surveillance (AS) has become the preferred management strategy for men with low risk prostate cancer. Despite widespread acceptance, many men that start AS will eventually progress and require treatment, though predicting this occurrence remains a challenging clinical dilemma. The objective of this study is to evaluate for clinical risk factors (RFs) that might aid in the risk stratification of these patients.
Methods: We performed a retrospective review of men on AS for low risk prostate cancer within the Northwell Health System. Records were queried for clinical RFs including PSA density (PSAD), total and free PSA, multiparametric MRI (mp-MRI) findings, and surveillance biopsy results. Univariate and multivariate Chi Square and Logistic Regression analyses were performed to test for associations between Gleason upgrade at last known follow up and clinical, laboratory, and imaging related RFs. Only patients meeting UCSF criteria for active surveillance at time of initial diagnosis were included in analyses (T1 or T2a, Gleason 6, less than 1/3 of total cores positive for cancer).
Results: 336 men were identified as having pursued an AS strategy for some length of time. Of those, 212/336 (63.1%) had had a total and free PSA, a mp-MRI, and had undergone at least 1 surveillance biopsy. 61 of 212 (28.8%) had Gleason upgrade at the time of last known surveillance biopsy. On univariate analyses, the following variables were statistically significant predictors of Gleason upgrade (Table 1): initial PSAD, initial PSAD < 0.10, initial %freePSA, initial PIRADS score, negative intervening biopsy, PSAD increase of at least 0.05. On multivariate analysis of PSAD, % Free PSA, and PIRADS score, initial PSAD remained a statistically significant predictor of Gleason upgrade (p = 0.032).
Conclusions: There are several clinical, laboratory, and imaging related risk factors that seem able to predict Gleason upgrade in patients on AS. Of these factors, PSAD, particularly at a cutoff of 0.1ng/ml/cc, was an independent predictor of upgrade. Given the abundance of risk factors clinicians can better counsel patients as to their suitability for remaining on AS or choosing earlier therapy.