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EAU 2019

EAU 2019: Total Cancer Location Density Score - A Predictor of Clinical Progression in Patients on Active Surveillance for Prostate Cancer

Barcelona, Spain (UroToday.com) The AUA recommends that a urologist offer active surveillance (AS) as a potential treatment plan for men with low-risk prostate cancer. The goal of AS is to prevent the potential morbidities that can occur with treatments such as radiation or surgery, while still allowing for careful monitoring of a man’s cancer to avoid clinical progression. One of the significant challenges of AS is to identify those men who are at risk of clinical progression and offer appropriately-timed intervention. 

As part of the expert-guided poster session on active surveillance in prostate cancer at the 2019 European Association of Urology (EAU) annual meeting in Barcelona, Spain, Dr. G.H. Tan from the Division of Urology at University Health Network in Toronto, Canada presented his group’s work on utilizing a novel way to potentially identify men at risk for clinical progression while on AS that they call Total Cancer Location (TCLo) density.

They retrospectively reviewed 181 men with low-risk prostate cancer on AS between 2012-2015 who underwent a confirmatory biopsy confirming the absence of intermediate or high-risk disease. They defined TCLo as the number of locations of positive cores at the time of diagnostic biopsy and confirmatory biopsy. They then divided this number by the patient prostate volume to calculate the TCLo density. They then correlated this value with the risk of a patient subsequently developing clinical progression or Gleason grade progression.

They found that a TCLo density score of >0.05 was independently associated with the time to clinical progression (HR 4.7), and Gleason grade progression (HR 4.25), and that TCLo density was more sensitive than the percentage of positive cores at biopsy at predicting clinical progression. Kaplan-Meier curves graphically showed that men with higher TCLo density had higher rates of progression to active treatment and higher grade progression.

Tan and his group concluded that TCLo density may be a potentially useful clinical tool to help stratify men who are at risk of clinical progression while on AS for low-risk prostate cancer. This may help clinicians to adapt AS protocols based on an individual man’s risk of progression. They believe that their findings should be ideally be validated in a larger, prospective cohort.

Presented by: G.H Tan, MD, University Health Network, Division of Urology, Toronto, Canada

Written by: Brian Kadow, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, Pennsylvania at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain from March 15-19, 2019.