Abstract: PD55-11
Sources of Funding: None

Introduction

Select patients with Gleason 7 prostate cancer (CaP) are managed by active surveillance (AS) at our institution. In fact, the most recent National Comprehensive Cancer Network (NCCN) guidelines have endorsed use of AS in patients with favorable-intermediate risk (FIR) CaP. The aim of this study is to assess oncologic and pathologic findings at radical prostatectomy (RP) in men classified by the NCCN risk strata.

Methods

This is an observational study of prospectively collected data of patients undergoing RP from 2005 to 2015. FIR CaP was defined as: Gleason grade 3+4, ≤50% of cores positive, and no more than one of the following: PSA >10 or clinical stage >T2a. Rates of adverse pathology at RP and biochemical recurrence (BCR) were compared in stratified analysis by NCCN risk grouping: very-low risk (VLR), low-risk (LR), FIR, and those with intermediate risk disease not meeting FIR criteria, termed unfavorable intermediate risk (UIR). Adverse pathology was defined as Gleason grade >3+4, extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node invasion (LNI), or a composite adverse pathology variable (AP).

Results

There were 1413 patients identified, of which 353 met criteria for FIR. The mean age of the entire cohort was 60.8 ± 6.7 years. with median follow-up time of 30.0 (IQR 11.7-42.2) months. Rates of AP increased accordingly with risk group (Table 1). The FIR group showed rates of AP between LR and UIR. On age-adjusted logistic regression analysis, risk grouping significantly correlated with AP (p<0.05). The cumulative survival-free BCR probabilities are also listed in Table 1, with the FIR group demonstrating rates more similar to VLR/LR than UIR. A Cox regression analysis controlling for age, ethnicity and prior biopsy status demonstrated similar hazard ratios (HR) for developing BCR in the LR (OR 6.1, 9% CI 1.3,28.8) and FIR (OR 5.88, 95% CI 1.3,25.8) groups, as opposed to higher HR in UIR ( OR 14.3, 95% CI 3.5, 59.1), when compared to the reference group (VLR).

Conclusions

Patients with FIR CaP have proportional rates of adverse pathology compared with lower risk CaP. However, intermediate-term clinical outcomes suggest more favorable clinical behavior, which may be related to the biology of these tumors. This has significant implications when considering patients for AS.

Funding

None