Presentation Authors: Daniel Halstuch*, Chen shenar, Sivan Sela, Yaara Ber, Daniel Kedar, Jack Baniel, David Margel, Petah Tiqva, Israel
Introduction: Men with germline mutations in the DNA-repair genes have a higher risk of developing prostate cancer. Moreover, germline mutations are associated with higher stage and grade and poor survival in patients with prostate cancer.Current guidelines recommend active surveillance as the preferred treatment modality for very low risk prostate cancer. However, many fear to offer this alternative to men with germline mutations. We offer active surveillance as the preferred treatment for men with germline mutations, diagnosed with low risk prostate cancer. The objective of this study is to describe the short term oncologic outcome of active surveillance in this cohort.
Methods: We perform an extensive screening protocol to all men with germline mutations including: PSA, mpMRI and MRI-US fusion biopsies. In this study we identified patients with germline mutation who were diagnosed with Grade Group 1 prostate cancer, between February 2014 to July 2017. Routine active surveillance follow-up consisted of PSA and DRE every 3 months, mpMRI and a MRI-US fusion confirmatory biopsy within one year of diagnosis. We now report the short term oncologic outcome of this unique group.
Results: We identified 12 patients with Grade Group 1 prostate cancer and germline mutations. Eight patients were carriers of mutation in the BRCA genes (4 BRCA1, 4 BRCA2), 4 with germline mutations in CHECK2 and 2 with MSH (Lynch syndrome). Median PSA was 5.2 ng/ml (IQR 3.2-7.6). Median age at diagnosis was 58 years (IQR 52-68). Eleven patients (92%) started active surveillance for prostate cancer. All patients were fully compliant with the follow up protocol. Confirmatory MRI-US fusion biopsies were performed in 9 (81%) patients at a median of 12 months from the initial biopsy. Two of the patients reclassified to Grade Group 2 and seven patients showed no upgrading of ISUP Grade Group. PSA kinetics was unable to predict upgrading. During the active surveillance period four patients were diagnosed with other malignancies: 1 breast cancer, 2 colon cancer and 1 malignant melanoma. Median follow-up time from the first biopsy is 14 months (IQR 10-19). Eight patients are still on active surveillance, asymptomatic and without evidence of progressive disease.
Conclusions: According to these preliminary results, active surveillance is feasible and safe among patients with germline mutations diagnosed with low risk prostate cancer. Carriers in our clinic are monitored very closely, and tend to be compliant. Therefore, the risk that the window of cure is missed is minimal.