Login to Access Video or Poster Abstract: MP47-10
Sources of Funding: This research was made possible through the National Institutes of Health (NIH) Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, The American Association for Dental Research, the Colgate-Palmolive Company, Genentech and alumni of student research programs and other individual supporters via contributions to the Foundation for the National Institutes of Health._x000D_ For a complete list, please visit the Foundation website at:_x000D_ http://fnih.org/work/education-training-0/medical-research-scholars-program

Introduction

As the use of MRI to diagnose prostate cancer (PCa) becomes established, knowledge of its effect on treatment patterns is needed to better counsel patients. We describe the distribution of PCa treatment modalities in the MRI/TRUS-fusion biopsy (FBx) era at our center to investigate the role of FBx in modulating PCa management patterns._x000D_

Methods

A retrospective review was performed on a prospectively maintained database of all men who underwent MRI/TRUS FBx at the National Institutes of Health from 2007 to present. Patient demographics, clinical data, imaging, pathology, treatment and outcomes were recorded. Patients were stratified by treatment into active surveillance (AS), radical prostatectomy (RP), radiation therapy (RT) +/- androgen deprivation therapy, or other therapy (including experimental treatments, focal laser ablation (FLA) or medical therapy). Groups were compared using t-test, Fischer exact test, and ANOVA (Graphpad prism software). Progression free survival was estimated using Kaplan-Meier curves (SPSS software).

Results

1260 men were reviewed (mean age 62.4 years; mean PSA 9.8 ng/dL). The overall PCa detection rate was 57.2% (n = 721). 517 men had available treatment data and either entered AS (38.9%, n=201), received RP (40.2%, n=208), RT +/- ADT (10.6, n=55), medical treatment (7.9%, n=41), or FLA (2.32%, n=12). The age, PSA, Gleason Scores (GI), and imaging characteristics are described for each of these groups in Table 1. Younger patients were more likely to choose RP over AS or RT (p<0.0001). The median PSA for those who received RT was higher than those on AS or who received RP (p<0.0001). The mean estimated progression free survival for AS was 105 months. The mean estimated BCR free survival was 71 months and 96 months for RP and RT, respectively (p=0.02). FBx upgrade (FBx GI > standard biopsy (SBx) GI) was significantly more common in patients who received either RP or RT when compared to SBx upgrade (p<0.0001).

Conclusions

MRI/TRUS-FBx use in the diagnosis of PCa results in more accurate assessment of disease burden and modulates treatment modality chosen by patients. FBx upgrade occurred in an increased proportion of patients choosing either RP or RT over AS. Further study is required to delineate the use and benefits of FBx when counseling patients on management options.

Funding

This research was made possible through the National Institutes of Health (NIH) Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation, The American Association for Dental Research, the Colgate-Palmolive Company, Genentech and alumni of student research programs and other individual supporters via contributions to the Foundation for the National Institutes of Health._x000D_ For a complete list, please visit the Foundation website at:_x000D_ http://fnih.org/work/education-training-0/medical-research-scholars-program