Abstract: PD55-10
Sources of Funding: None.

Introduction

NCCN active surveillance (AS) guidelines have recently expanded to include select intermediate-risk prostate cancer patients, but data supporting the safety of AS in these patients are limited. We compare the pathologic and oncologic outcomes of these favorable intermediate-risk patients to very low, low, and unfavorable intermediate-risk patients in a cohort of radical prostatectomy (RP) patients.

Methods

Patients in our prospectively maintained database meeting NCCN very low (T1c, Gleason ≤6, ≤3/12 cores, ≤50% core volume, and PSA density <0.15), low (T1-T2a, Gleason ≤6, PSA <10), favorable intermediate (major pattern grade 3, ≤3/12 cores, ≤50% core volume, and only ONE intermediate risk factor [T2b/c, Gleason 7, or PSA 10-20]), or unfavorable intermediate (all other intermediate) risk criteria were identified. Incidence of adverse pathologic findings at RP (Gleason score upgrading to primary pattern 4 or 5, non-organ confined disease) was compared between favorable intermediate and very low / low-risk groups (chi-squared test). Kaplan-Meier analysis compared biochemical progression free survival among all groups.

Results

3669 patients underwent RP between 1/1/04 and 12/31/15. Of these, 1454, 251 and 1361 patients fulfilled criteria for very low/low, favorable intermediate, and unfavorable intermediate-risk groups, respectively. Median follow-up was 37 months. Patients in the favorable intermediate group had significantly higher rates of Gleason score upgrading (16% vs 6%; p<0.001) and non organ-confined disease (16% vs 11%; p=0.035) than those in low risk group. Time to biochemical recurrence for the favorable intermediate group did not differ significantly from the low risk group (p=0.057), but was significantly longer than unfavorable intermediates (p=0.003) (Figure 1).

Conclusions

Compared to very low/low risk prostate cancer patients, men with favorable intermediate-risk disease had significantly higher rates of more aggressive, non-organ confined disease at RP, and trended toward worse biochemical progression free survival. However, when compared to unfavorable intermediate risk patients, it appears the magnitude of these differences would not preclude AS as a reasonable option for appropriately selected patients with favorable intermediate risk prostate cancer.

Funding

None.