Pd45-12 Factors Associated With Pathological Reclassification of Low Risk Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Staging II (PD45)1 May 2024PD45-12 FACTORS ASSOCIATED WITH PATHOLOGICAL RECLASSIFICATION OF LOW RISK PROSTATE CANCER Austin Y. Ho, Eric Li, Richard Bennett, Jonathan Aguiar, Sai Kumar, Clayton Neill, Zequn Sun, Edward Schaeffer, Hiten Patel, and Ashley Ross Austin Y. HoAustin Y. Ho , Eric LiEric Li , Richard BennettRichard Bennett , Jonathan AguiarJonathan Aguiar , Sai KumarSai Kumar , Clayton NeillClayton Neill , Zequn SunZequn Sun , Edward SchaefferEdward Schaeffer , Hiten PatelHiten Patel , and Ashley RossAshley Ross View All Author Informationhttps://doi.org/10.1097/01.JU.0001008792.09108.b4.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is the preferred management for low grade prostate cancers. Predictors of reclassification to disease requiring treatment (best defined as presence of unfavorable intermediate risk cancer or greater) can inform men choosing AS of their likelihood to remain untreated over time. Here we analyze clinical and radiographical factors associated with clinically significant reclassification. METHODS: We retrospectively identified 629 men initially diagnosed with AUA low risk (LR) prostate cancer across our eleven-hospital system from January 2018 – September 2022. Definitions of reclassification were made either strictly on histopathology or as a combined definition including treatment. Univariable and multivariable logistic regression analysis was performed with statistical significance defined as a p<0.05. RESULTS: Among LR men, 93 (15%) opted for immediate treatment with radical prostatectomy (RP). Of those, 7 were found to have adverse pathology (AP) defined as Gleason Grade Group (GG) 3-5 disease. There were no significant differentiators among men with AP including NCCN very low risk (VLR) or LR risk, other metrics of disease volume, or MRI PIRADS score. When considering diagnostic features of AUA LR men opting for surveillance (median follow up time 485 days (307, 973)), reclassification to GG3-5 disease was only significantly associated with MRI PIRADS score (HR 6.6 (95% CI 1.5-27.9) for PIRADS 5 MRI prior to initial diagnosis) and logPSA density (PSAD) (HR 3.14 (95% CI, 1.14-8.65). Other tested risk factors including NCCN risk group, % positive cores, and maximum individual core positivity were only statistically significant when considering outcomes that included reclassification to GG2 disease or treatment for any cause. CONCLUSIONS: Among AUA low risk men undergoing surveillance, the presence of a PIRADS 5 lesion at diagnosis and higher PSAD were predictive of reclassification to GG3-5 disease. NCCN VLR or LR designations, and histological measurements of disease volume were only predictive of events when considering progression to treatment for any reason or when including questionably meaningful GG 2 pathological reclassifications. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e972 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Austin Y. Ho More articles by this author Eric Li More articles by this author Richard Bennett More articles by this author Jonathan Aguiar More articles by this author Sai Kumar More articles by this author Clayton Neill More articles by this author Zequn Sun More articles by this author Edward Schaeffer More articles by this author Hiten Patel More articles by this author Ashley Ross More articles by this author Expand All Advertisement PDF downloadLoading ...