Login to Access Video or Poster Abstract: MP43-13
Sources of Funding: None

Introduction

Evaluate the biochemical recurrence free survival (bRFS) in men after radical prostatectomy (RP) triggered by Gleason score (GS) grade reclassification (GR) during active surveillance (AS) in order to inform patient decisions.

Methods

We conducted a retrospective analysis of men undergoing RP from 1995-2015 and identified 2 groups; 122 men in AS who underwent RP following GR (7(3+4) or greater, grade group 2 and above) and 4433 men who underwent immediate RP (IRP) following a diagnosis of grade group 2 and above. bRFS was assessed using Kaplan Meir and multivariate Cox regression analyses.

Results

Of 122 men in AS, 13 (10.7%) had biochemical recurrence (BCR) as compared to 777 of 4,433 (17.5%) men that underwent IRP (p =0.007). As compared to the IRP group, men on AS were significantly older (p <0.001), had a higher proportion of low volume cancers (p <0.001), a lower PSA density (p =0.001), and a lower rate of GS upgrade at surgery (p <0.001). bRFS was higher for men in the AS cohort compared to IRP group (p = 0.046, Fig 1). After adjustment for confounders, the difference in bRFS between groups was no longer significant (HR = 0.77; 95% CI, 0.41 to 1.46).

Conclusions

AS patients that are reclassified to grade group 2 and above have a higher bRFS after surgery as compared to those undergoing IRP with similar grade disease. These differences are likely due to selection criteria for AS. Our findings help inform patient decisions regarding the risk of entering an AS program.

Funding

None