ASCO 2017: Comparison of biochemical recurrence free survival after radical prostatectomy triggered by grade reclassification on active surveillance, and men newly diagnosed with similar grade disease
This was a retrospective analysis of men undergoing RP from 1995 - 2015 at Johns Hopkins and identified 4 groups:
1. 94 men in AS that underwent RP following grade reclassification from Gleason score (GS) 6 to GS > =7(3+4) [grade groups ≥ 2]
2. 3,504 men that underwent IRP following a diagnosis of grade groups >= 2
3. 56 men in AS that underwent RP following grade reclassification to GS 7(3+4) [grade group 2]
4. 1,979 men that underwent IRP following a diagnosis of grade group 2.
The outcome of interest was BCRSF.
Results demonstrated that men on AS had a lower PSA density distribution (0.11 vs. 0.13, p = 0.022; 0.12 vs. 0.12, p = 0.043), and a higher proportion of low volume cancers (46.2% vs. 15.3%, 46.4% vs. 16.7%, both p < 0.001) as compared to the IRP groups for both biopsy grade groups ≥ 2 and biopsy grade group 2, respectively. The proportions of men with biochemical recurrence (BCR) in the AS and IRP groups were 13.8% vs. 29.1% (p = 0.008 for grade groups ≥ 2) and 8.9% vs. 21.7% (p = 0.022 for grade group 2), respectively. One, 5, 10-year BCRFS for men in the AS group vs the IRP group was 97.9%, 76.6%, 69.0% vs 85.5%, 65.1% ,54.2%%, respectively for biopsy grade groups ≥ 2 (log-rank test, p = 0.009), and 96.4%, 89.6%, 89.6% vs 91.2%, 74.0%, 63.9%, respectively for biopsy grade group 2 (log-rank test, p = 0.071).
In summary, AS patients that are reclassified to grade groups ≥ 2 have a higher BCRFS compared to men initially diagnosed with similar grade disease that underwent IRP. The difference could be attributed to stricter selection criteria of men on AS, based on PSA density and cancer volume. These data allow physicians to reassure patients with grade reclassification on AS that their prognosis does not appear to be adversely affected relative to IRP.
Presented By: Clarissa P. Diniz, The Johns Hopkins University School of Medicine, Baltimore, MD
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
Twitter: @GoldbergHanan
at the 2017 ASCO Annual Meeting - June 2 - 6, 2017 - Chicago, Illinois, USA