Presentation Authors: Srinath Kotamarti*, Brooklyn, NY, Andrew Wood, New Hyde Park, NY, Alyssa Yee, Brooklyn, NY, Daniel Rabinowitz, Allison Marziliano, New Hyde Park, NY, Jose Vilaro, Brooklyn, NY, Eran Ben-Levi, Robert Villani, Michael Diefenbach, Manish Vira, Simon J. Hall, New Hyde Park, NY
Introduction: For select men with prostate cancer (PCa), Active Surveillance (AS) offers adequate monitoring of disease while avoiding potential treatment-associated morbidity. Based on various factors, criteria from Johns Hopkins (JHU) and the University of California-San Francisco (UCSF) stratify patients into very low risk (VLR) and low risk (LR) categories, respectively. We sought to compare VLR and LR patients in terms of follow up biopsy outcomes over time.
Methods: The Northwell Urology Prostate Biopsy database was queried, identifying men on AS. Those meeting JHU criteria or UCSF criteria were selected. Surveillance biopsies were categorized by time intervals: 1-2, 2-4, and 4-6 years post diagnosis. Chi Square analyses were then undertaken at each time interval between criteria to compare rates of Gleason score upgrade and overall biopsy progression (defined by biopsy parameters no longer falling within UCSF criteria).
Results: A total of 331 patients on AS met UCSF criteria. 125 patients were found to fulfill VLR criteria, leaving 206 patients in the LR group. Chi Square analyses comparing LR and VLR regarding Gleason upgrade at surveillance biopsy were insignificant at all of the following intervals: at 1-2 years (VLR 22.0% versus LR 23.5%, p=NS), at 2-4 years (VLR 16.4% versus 25.6%, p=NS), and at 4-6 years (VLR 20.0% versus LR 15.4%, p=NS). Overall biopsy progression was also insignificantly different between criteria at all time points: at 1-2 years (VLR 22.0% versus LR 28.4%, p=NS), at 2-4 years (VLR 20.0% versus LR 27.9%, p=NS), and at 4-6 years (VLR 25.0% versus LR 23.1%, p=NS).
Conclusions: Over various time points spanning six years, VLR patients had no significant advantages in rates of Gleason score upgrade or overall biopsy progression on follow up biopsy compared to LR patients. Thus, men with lesser PCa regardless of criteria should be closely monitored for disease progression with surveillance biopsy. PCa patients selected with the stricter JHU criteria likely cannot and should not be offered a less vigilant surveillance regimen.