MP74-16: Validation of the European Association of Urology Biochemical Recurrence Risk Groups After Radical Prostatectomy in an Asian Cohort and Suggestions for Refinement

Sahyun Pak, Donghyun Lee, Dalsan You, In Gab Jeong, Jae Young Joung, Kang Hyun Lee, Jun Hyuk Hong, Choung-Soo Kim, Hanjong Ahn

Introduction: Recently, the novel European Urology Association (EAU) biochemical recurrence (BCR) risk grouping using prostate-specific antigen doubling time (PSADT) and pathologic Gleason score (pGS) was proposed to predict metastatic progression and cancer-specific death, and was validated in a European cohort. This study aimed to validate the prognostic utility of EAU BCR risk grouping in an Asian cohort and to evaluate whether refinement is necessary.

Methods: This multi-center retrospective study analyzed 1,117 patients who experienced BCR after radical prostatectomy between 1998 and 2014. Survival outcomes were determined using Kaplan-Meier method and compared with log-rank tests. The independent predictability of risk grouping was assessed by multivariable analysis using a Cox model.

Results: The 7-year rates of distant metastasis-free survival (93.7% vs. 72.0%, p<0.001) and cancer-specific survival (97.3% vs. 85.9%, p=0.003) from time of BCR was significantly higher in patients with low EAU BCR risk (PSADT >1 year and pGS <8) compared than those with high EAU BCR risk (PSADT =1 year or pGS 8–10). Among high BCR risk group, patients with PSADT 6-12 months and pGS 6-7 had significantly higher rates of distant metastasis-free survival and cancer-specific survival than those with PSADT =6 months or pGS 8-10, and showed similar outcomes as compared with low BCR risk group. The survival benefit of early salvage radiotherapy was limited to patients with PSADT =6 months or pGS 8-10. The time-dependent c-index, which predicted metastatic progression and cancer-specific death, was improved when the PSADT cut-off point was set at 6 months.

Conclusions: EAU BCR risk stratification demonstrated the ability to reliably identify patients who might be at increased risk of metastasis and cancer-specific mortality in our cohort. However, the PSADT cut-off point for high-risk BCR may be not appropriate to optimize predictive performance and utility in clinical practice. Further validation and refinement are needed. Source of

Funding: None