Presentation Authors: Jozien Helleman*, Sebastiaan Remmers, Daan Nieboer, Chris Bangma, Monique Roobol, Rotterdam, Netherlands, Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3), Melbourne, Australia
Introduction: Active surveillance (AS) has become an increasingly utilized management strategy for patients with low-risk prostate cancer (PCa). Some institutes have expanded the inclusion criteria to grade-group 2 (GG2) intermediate-risk PCa. Our aim was to assess potential differences in incidence, reason for discontinuation and treatment choice between men with GG1 and GG2 PCa within the Movember Foundation&[prime]s Global Action Plan Prostate Cancer Active Surveillance initiative (GAP3) database.
Methods: The GAP3 initiative has the largest centralised PCa AS database to date including data of over 15,000 men on AS. For this analysis, we excluded data from 11 of the 25 participating institutes for which no or < 4% of men had GG2 PCa at inclusion. We compared data from 7,704 men on AS from 14 centres across 8 countries; 6,725 men with GG1 (87%) and 979 men with GG2 (13%) PCa at time of inclusion. Cumulative incidence curves were used to estimate rates of AS discontinuation and treatment choice.
Results: Men with GG2 disease are older at time of inclusion (median of 69 vs 65 years, p < .001) which might be one of the reasons for the increased proportion of men receiving hormonal therapy after discontinuation of AS (Figure 1C-D). 53% and 71% of men with GG2 have stopped AS compared to 38% and 57% of men with GG1 (Figure 1A-B) at 5 and 10 years follow-up respectively. The proportion of men dropping out without evidence of progression is higher for men with GG2 PCa compared to GG1 PCa (at 5 and 10 years: 18% and 21% vs 2% and 4%)(Figure 1A-C). The proportion of men receiving radical prostatectomy (RP) is similar during 5 and 10 years follow-up as well as the percentage of men experiencing adverse pathology at RP (5.0% GG1 vs 5.5% GG2, defined as: â‰¥ pT3, or pT2 with positive surgical margins, or N+, or pathological Gleason â‰¥ 4+3).
Conclusions: Our descriptive analyses of current AS practices worldwide showed that of the men selected for AS, only 13% had GG2 disease at inclusion and their dropout rate is higher at 5 and 10 years of follow-up. Of note is that, besides having similar rates of adverse pathology at RP, men with GG2 disease at time of inclusion more often discontinue AS without evidence of disease progression. This might suggest increased anxiety of the urologist and/or patient.
Source of Funding: This work was supported by the Movember Foundation. The funder did not play any role in the study design, collection, analysis or interpretation of data, or in the drafting of this paper.