Presentation Authors: Jonathan B. Bloom*, Bethesda, MD, Sam A. Gold, Brooklyn, NY, Graham R. Hale, Philadelphia, PA, Amir H. Lebastachi, Michael Ahdoot, Sandeep Gurram, Vladimir Valera, Sherif Mehralivand, Thomas Sanford, Bradford Wood, Maria J. Merino, Peter L. Choyke, Howard L. Parnes, Baris Turkbey, Peter A. Pinto, Bethesda, MD
Introduction: Active Surveillance (AS) is increasingly utilized to manage very-low (VLR), low (LR), and some favorable intermediate risk (IR) prostate cancer (PCa). Most studies examining AS outcomes have been based on standard 12-core systematic biopsies (SB). We examined the outcomes of patients who were selected for AS after undergoing multi-parametric magnetic resonance imaging (mpMRI) with fusion guided biopsies (FB) of MRI-detected lesions in addition to SB.
Methods: A retrospective review was conducted of all patients with Gleason Grade Group (GG) 1 (Gleason Score 3+3) or 2 (Gleason Score 3+4) PCa managed initially with AS. Kaplan-Meier graphs were constructed to determine the time patients continued AS and time for GG progression free-survival (PFS). Cox proportions hazard regression was performed to determine factors significant for GG progression. Those who underwent radical prostatectomy had their final pathology examined for adverse pathology (GG>2 or â‰¥T3 disease)
Results: 246 (172 GG 1 and 74 GG 2) patients met inclusion criteria. The median time remaining on AS for the GG 1 group was not reached (although nearing 96 months) and for the GG 2 group was 53.88 months, p < 0.01. Median time for GG PFS for the GG 1 and GG 2 groups were 57.27 and 45.11 months, respectively, p=0.03. Significant variables for progression included age (HR 1.05 95% CI 1.01-1.09, p < 0.01), PSA density (HR 1.03 95% CI 1.01-1.09, p=0.01, size of the largest lesion on mpMRI (HR 1.66 95% CI 1.07-2.57, p=0.02) and the number of targeted biopsy cores positive for cancer (HR 1.24 95% CI 1.03-1.50, p=0.02). None of the AS patients who went on to RP had positive margins or lymph nodes. AP occurred in 3/18 (16.7%) of patients starting with GG 2 disease.
Conclusions: mpMRI-directed FB provides an effective way to select and monitor patients with LR PCa on AS. This additional information helps in predicting which patients will progress on AS.
Source of Funding: This research was supported by the Intramural Research Program of the National Cancer Institute, NIH.