MP23-13: Defining Intermediate-Risk Prostate Cancer Suitable for Active Surveillance with PSA 10-20ng/ml: pathological outcome analysis of a population-level dataset

Peter E Lonergan, Chang Wook Jeong, Samuel L Washington, Annika Herlemann, Peter R Carroll, Matthew R Cooperberg

Introduction: The most recent National Comprehensive Cancer Network prostate cancer guidelines use grade group (GG) 2 or PSA 10-20 ng/mL as features that define favorable intermediate-risk disease and suggest that active surveillance (AS) may be an option for some men within this risk category. As a result, there is a need to more clearly define AS eligibility within this group. To address this, we utilized the Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting (SEER-WW) database to determine the risk of pathologic upgrading or upstaging according to PSA level (<10 vs 10-20 ng/mL) and GG (1 vs 2) in men with favorable intermediate-risk localized prostate cancer who underwent radical prostatectomy (RP).

Methods: The study population was obtained from the SEER-WW database, which captures men diagnosed with prostate cancer from 18 regional registries between 2010 and 2016. After multiple imputation, the cohort was restricted to men aged =80 years with clinically localized prostate cancer (cT1-2cN0M0), PSA =20ng/ml, biopsy GG =2 with percent positive cores (PPC) =33% who underwent RP (n=29,120). Patients with no surgical pathology information were excluded (n=2,572), giving a final patient cohort of 26,548 for the analyses. The primary outcome was adverse pathology, defined as any pathologic upgrading (=GG 3) or any upstaging to non-organ confined disease (=pT3a). Multivariable logistic regression was performed to determine predictors of adverse pathology at RP.

Results: Of 1,731 men with GG 1 disease and PSA 10-20 ng/mL, 382 (22.1%) harbored adverse pathology compared to 2,340 (28%) of 8,367 men with GG 2 and a PSA <10 ng/mL who had adverse pathology. The odds ratio of harboring adverse pathology with a PSA 10-20 ng/mL (vs <10 ng/mL, 1.87, 95% confidence interval [CI] 1.71-2.05, p<.001) was smaller than that of GG 2 (vs. GG 1, 2.56, 95% CI 2.40-2.73, p<0.001) after adjustment.

Conclusions: Using data from the SEER-WW database, our findings show that men with GG 1 disease and a PSA of 10-20 mg/mL have a lower risk of adverse pathology after RP compared to men with GG 2 and a PSA <10 ng/mL. Our results support the expanding role of AS to men with PSA 10-20 ng/mL for GG 1 prostate cancer, which should be accompanied by informed decision-making. Source of

Funding: None