Pd45-04 Does Dre Add Value to the Aua Prostate Cancer Risk Stratification?

You have accessJournal of UrologyProstate Cancer: Staging II (PD45)1 May 2024PD45-04 DOES DRE ADD VALUE TO THE AUA PROSTATE CANCER RISK STRATIFICATION? Madison Krischak, Samuel Kaffenberger, Jeffrey Montgomery, Ganesh Palapattu, Tudor Borza, Alice Semerjian, Simpa Salami, Todd Morgan, and Kristian Stensland Madison KrischakMadison Krischak , Samuel KaffenbergerSamuel Kaffenberger , Jeffrey MontgomeryJeffrey Montgomery , Ganesh PalapattuGanesh Palapattu , Tudor BorzaTudor Borza , Alice SemerjianAlice Semerjian , Simpa SalamiSimpa Salami , Todd MorganTodd Morgan , and Kristian StenslandKristian Stensland View All Author Informationhttps://doi.org/10.1097/01.JU.0001008792.09108.b4.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical staging of patients with prostate cancer relies on digital rectal exam (DRE) findings to distinguish between cT1 and cT2 disease and to sub-stage based on the extent of palpable disease. While DRE has been effectively omitted from some risk stratification schema (eg CAPRA where T1 and T2 are considered equivalent), DRE is still used to differentiate low vs intermediate risk disease within the AUA stratification and can influence clinical management. With increasing MRI use, how much DRE adds to estimates of prostate cancer risk within the AUA system in recent years is unclear. For these reasons, we assessed the impact of DRE findings in the AUA risk schema on stratifying overall survival of patients with prostate cancer. METHODS: We accessed prostate cancer cases from the National Cancer Database from 2004-2020. We coded each case using the AUA prostate cancer risk stratification. We then created new risk categories for low-risk patients with cT2a (ie single palpable nodule), and otherwise low risk patients (ie PSA <10 and GG1) with cT2b-c (ie extensive palpable disease). We compared overall survival with Kaplan-Meier methods. We additionally compared survival between these groups restricted to patients (n=610,037) receiving prostatectomy or radiation. RESULTS: There were 784,895 cases of localized prostate cancer with staging data available, with 199,268 low-risk cases. Of these, 16,175 had cT2a disease. There were 8,627 cases with cT2b-c disease who otherwise met low-risk criteria (ie PSA <10 and GG1). Survival for patients receiving prostatectomy or radiation was similar between AUA low risk, AUA low risk with cT2a, and patients with cT2b-c but otherwise low risk disease at 5 years (96.4%, 95.9%, 95.9%) and 10 years (87.9%, 86.7%, 87.2%); all these groups had better survival than favorable or unfavorable intermediate risk at 5 years (94.9%, 93.3%) and 10 years (83.4%, 78.6%). CONCLUSIONS: This study proposes that DRE findings, while currently a key component of AUA prostate cancer risk stratification, do not provide added value to predicting overall survival in low-risk patients. These data suggest omission of DRE from the AUA risk strata, or use of simpler scores like CAPRA, may be as effective in risk stratification in the current era. However, the influence of palpable nodules on active surveillance outcomes requires further study. Download PPT Source of Funding: Dr. Stensland is supported by NIH K12 DK111011 and NIH P30-CA046592 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e968 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Madison Krischak More articles by this author Samuel Kaffenberger More articles by this author Jeffrey Montgomery More articles by this author Ganesh Palapattu More articles by this author Tudor Borza More articles by this author Alice Semerjian More articles by this author Simpa Salami More articles by this author Todd Morgan More articles by this author Kristian Stensland More articles by this author Expand All Advertisement PDF downloadLoading ...