Presentation Authors: Jacob W. Greenberg, Gabriel Z. Leinwand*, Amanda Raines, M.D, Jason Chiang, M.D, L. Spencer Krane M.D, Jonathan L. Silberstein, M.D, FACS, New Orleans, LA
Introduction: Active surveillance (AS) is becoming the de facto standard of care for men with low risk prostate cancer. Due to various risk factors, certain groups of men are deemed to be at higher risk for progression. These groups are considered by some to be poor candidates for active surveillance. We sought to determine predictors of subsequent upgrading in a multiracial group of men with low risk prostate cancer electing active surveillance protocol as treatment.
Methods: A prospective database study was performed at the South Louisiana Veterans Administration Medical Center (SLVHCS), New Orleans, LA. Inclusion criteria for this study were at least two overall prostate biopsies, with a diagnostic biopsy demonstrating prostate cancer in any NCCN risk group. From the large multiracial database of 274 men on AS, 190 men were shown to have at least two overall biopsies and include into this study. Univariate and multivariate regressions were performed using R version 3.5.1 (Berkeley, CA). The specific tests were chosen to allow for detection of a significant risk factor for pathologic upgrade in both categorical and continuous variables.
Results: This group consisted of 190 men, 126 African Americans (AA), and 64 Caucasian American (CA) men. The median age of this group was 68 at diagnosis, with no significant difference between age of AA and CA men. Median BMI of cohort was 29.08, with no significant difference in BMI when divided by race. Upon univariate regression analysis BMI (p=0.22), family history of PCa (p=0.64), PSA at diagnosis (p=0.2), PSA density (p=0.13), age (p=0.72), and race (p=0.66) were not statically significant predictors of pathologic upgrade. Greater time on active surveillance (p=0.0083), increasing prostate volume on transrectal ultrasound (p=0.05), and increasing number of positive cores (p=0.0001) were statically significant for Gleason upgrading on univariate regression.When evaluating these variables in multivariate regression, analysis revealed increasing time on AS (p=0.047) and increasing number of positive cores (p=0.027) were statically significant predictors of Gleason upgrading. TRUS volume (0.71) age, race, BMI, family history, PSA and PSA density at diagnosis were not found to be predictors of Gleason upgrading on multivariate analysis.
Conclusions: Within a multiracial cohort of men electing AS, race did not predict upgrading on subsequent biopsy. In this cohort the volume of positive cores on baseline biopsy was predictive of subsequent pathologic upgrade as was duration of time on AS.