Pd26-04 Contemporary Diagnosis of Very Low Risk Prostate Cancer in a Multi-Centered Hospital System

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD26)1 May 2024PD26-04 CONTEMPORARY DIAGNOSIS OF VERY LOW RISK PROSTATE CANCER IN A MULTI-CENTERED HOSPITAL SYSTEM Richard Bennett, Eric V. Li, Austin Y. Ho, Jonathan Aguiar, Ashorne K. Mahenthiran, Sai Kumar, Zequn Sun, Chalairat Suk-ouichai, Clayton Neill, Edward M. Schaeffer, Anugayathri Jawahar, Hiten D. Patel, and Ashley E. Ross Richard BennettRichard Bennett , Eric V. LiEric V. Li , Austin Y. HoAustin Y. Ho , Jonathan AguiarJonathan Aguiar , Ashorne K. MahenthiranAshorne K. Mahenthiran , Sai KumarSai Kumar , Zequn SunZequn Sun , Chalairat Suk-ouichaiChalairat Suk-ouichai , Clayton NeillClayton Neill , Edward M. SchaefferEdward M. Schaeffer , Anugayathri JawaharAnugayathri Jawahar , Hiten D. PatelHiten D. Patel , and Ashley E. RossAshley E. Ross View All Author Informationhttps://doi.org/10.1097/01.JU.0001008556.20565.76.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: NCCN very low risk (VLR) prostate cancer is considered clinically insignificant. Use of MRI prior to patient selection for prostate biopsy can reduce the diagnosis of VLR disease. Indeed, a recent publication has reported no VLR diagnoses since 2018. We sought to better understand the incidence of VLR disease in our multi-hospital institutional cohort. METHODS: We retrospectively identified 3197 patients who were newly diagnosed with prostate cancer at our eleven hospital system from January 2018 – June 2023. Patient clinical, pathological, and imaging characteristics were collected for analysis. Biopsies were considered MRI-informed if MRI was performed within two years prior to prostate biopsy. Risk of clinically significant prostate cancer before biopsy was determined using the My nMRIsk calculator. Welch's two-sample t-test, Pearson's chi-squared test, and Fisher's exact tests were performed to compare clinical characteristics. RESULTS: 11% (351/3195) of men diagnosed with prostate cancer were classified as NCCN very low risk. VLR disease incidence was steady from 2018-2023 (p=0.8) despite increased usage of MRI-informed biopsies (p<0.001). Use of MRI-informed biopsy was similar for detection of VLR and higher risk disease (68% vs 72%, p=0.07, Figure 1). Of VLR patients who received a targeted biopsy, 69% (127/184) of disease was found in systematic regions only, 21% (39/184) was found in targeted regions only, and 10% (18/184) was found both systematically and in targeted regions. On multivariable analysis, black race, logPSA, and PIRADS 4 and 5 regions were negatively associated with VLR disease. 86% (304/351) of VLR patients chose active surveillance as their initial disease management. Use of My nMRIsk calculator would limit VLR diagnosis by 41% (97/239) with a <=5% tolerance for biopsy of Gleason grade (GG) 3 and higher disease and 34% (82/239) with <=15% tolerance for biopsy of GG2 and higher disease (Figure 1). CONCLUSIONS: VLR disease comprises a significant minority of prostate cancer diagnoses. The incidence of VLR has remained unchanged despite increased utilization of MRI-informed biopsies. In the majority of cases the diagnosis of VLR is made from the template biopsy (whether MRI-informed or not). Use of pre-biopsy risk calculators can limit the diagnosis of this clinically insignificant disease. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e544 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Richard Bennett More articles by this author Eric V. Li More articles by this author Austin Y. Ho More articles by this author Jonathan Aguiar More articles by this author Ashorne K. Mahenthiran More articles by this author Sai Kumar More articles by this author Zequn Sun More articles by this author Chalairat Suk-ouichai More articles by this author Clayton Neill More articles by this author Edward M. Schaeffer More articles by this author Anugayathri Jawahar More articles by this author Hiten D. Patel More articles by this author Ashley E. Ross More articles by this author Expand All Advertisement PDF downloadLoading ...