Presentation Authors: Jonathan B. Bloom*, Amir H. Lebastachi, Michael Ahdoot, Sandeep Gurram, Bethesda, MD, Sam A. Gold, Brooklyn, NY, Graham R. Hale, Philadelphia, PA, Sherif Mehralivand, Thomas Sanford, Vladimir Valera, Bradford Wood, Maria J. Merino, Peter L. Choyke, Howard L. Parnes, Baris Turkbey, Peter A. Pinto, Bethesda, MD
Introduction: Active Surveillance (AS) is increasingly utilized to manage more patients with prostate cancer (PCa) including those with favorable intermediate risk (IR) prostate cancer (PCa). Patients with IR PCa on systematic biopsy (SB) have been shown to be at increased risks of adverse pathology (AP) at the time of radical prostatectomy (RP) as compared to lower risk patients. This often leads to reluctance from both urologists and patients in choosing AS as a treatment strategy. This study sought to determine the rate of AP of patients with Gleason Score (GS) 3+4 on targeted biopsy (TB) and any associated imaging, biopsy, or clinical factors.
Methods: A retrospective review was conducted of all patients with Gleason Score 3+4 PCa found on TB who elected treatment with RP. All patients underwent TB of a demonstrable lesion after multiparametric magnetic resonance imaging (mpMRI) as well as SB. These patients then elected for radical prostatectomy. Multivariable logistic regression was then performed of imaging, SB and TB results, and patient characteristics to determine factors associated with AP as defined by either GS > 3+4, pathologic stage â‰¥ T3 disease, or positive lymph nodes.
Results: A total of 121 were found to have Gleason 3+4 on TB and then elected for RP. Of these patients, 30 (24.8%) were found to have AP after RP consisting of 22 with extraprostatic extension, 11 with GS > 3+4, 3 with seminal vesicle invasion and one with lymph node positive disease. After multivariable logistic regression, factors associated with AP were age (HR 1.13 95% CI 1.03-1.23, p=0.01) and the highest percentage of targeted core positive for PCa (HR 11.9 95% CI 1.45-98.05, p=0.02). A subset analysis was performed of only those with highly suspicious mpMRI lesions based on an in-house scoring system and significant factors after multivariable logistic regression were PSA (HR 1.42 95% CI 1.04-1.94, p=0.03) and the size of the mpMRI lesion (HR 0.15 95% CI 0.04-0.63, p=0.04)
Conclusions: Nearly 25% of patients with GS 3+4 on TB had AP at the time of RP. Older age and a higher percentage of the TB biopsy core with cancer were associated with AP. Surprisingly, with highly suspicious lesions, smaller lesions were more likely to yield AP which may be due to the difficulty in accurately sampling these lesions. These results may help select appropriate candidates for AS with GS 3+4 PCa after mpMRI and TB.
Source of Funding: Supported by the Intramural Research Program of the NIH (National Institutes of Health).