Downgrading of grade group 2 intermediate‐risk prostate cancer from biopsy to radical prostatectomy: Comparison of outcomes and predictors to identify potential candidates for active surveillance

124 Background: A biopsy-based RT-PCR assay (Oncotype DX Prostate Assay) providing a Genomic Prostate Score (GPS) as a measure of tumor aggressiveness has been validated as a predictor of adverse pathologic and oncologic outcomes. We sought to evaluate the change in GPS results among men with favorable-risk prostate cancer (PCa) managed with active surveillance (AS). Methods: We identified men with low and intermediate-clinical risk PCa managed with AS at our institution receiving a minimum of two GPS tests on serial prostate biopsy. GPS ranges from 0 (least) to 100 (most aggressive disease). We described the change in assay results and clinical risk designation over time and reported the subsequent clinical outcome (definitive treatment versus continued AS). For men receiving treatment with radical prostatectomy (RP) the occurrence of adverse pathological findings was defined by the presence of high grade (Gleason pattern ≥ 4+3) or non-organ confined disease ( ≥ pT3a). Results: 31 men were identified who underwent serial GPS testing at a median of 12 months. The median change in GPS was an increase of 1 point (IQR -7, 13). Fourteen (45%) patients experienced an increase in NCCN risk classification, including 3 from very-low to intermediate and 11 from low to intermediate risk. Following serial GPS testing 7 patients (23%) underwent radical prostatectomy. Among surgically treated patients, 3 had adverse pathology due to pT3a disease and the mean change in GPS prior to treatment was an increase of 13 points (IQR -7, 18); all of whom were intermediate clinical risk at the time of surgery. This study was limited by the small sample size and the uncontrolled decision to pursue definitive therapy. Conclusions: Serial change in a tissue based gene expression assay on serial biopsy during AS was non-static. Magnitude of GPS change may identify men at risk for adverse pathological findings, although larger series are required to validate such an endpoint during AS.

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Subtyping the Risk of Intermediate Risk Prostate Cancer for Active Surveillance Based on Adverse Pathology at Radical Prostatectomy

The Journal of Urology ◽

10.1016/j.juro.2018.04.058 ◽

2018 ◽

Vol 200 (5) ◽

pp. 1068-1074 ◽

Cited By ~ 5

Author(s):

Hiten D. Patel ◽

Mohit Gupta ◽

Jeffrey J. Tosoian ◽

H. Ballentine Carter ◽

Alan W. Partin ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Intermediate Risk ◽

Risk Prostate Cancer

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Active surveillance in favorable intermediate-risk prostate cancer patients: Predictors of deferred intervention and treatment choice

Canadian Urological Association Journal ◽

10.5489/cuaj.7272 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Rashid K. Sayyid ◽

Laurence Klotz ◽

John Z. Benton ◽

Merry Ma ◽

Phillip Woodruff ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Clinical Stage ◽

Treatment Choice ◽

Intermediate Risk ◽

Treatment Type ◽

Definitive Therapy ◽

Risk Prostate Cancer ◽

Choice Of Treatment ◽

Group 2

Introduction: Active surveillance (AS) is increasingly used for favorable intermediate-risk (FIR) prostate cancer (PCa). Our objective was to determine oncological and sociodemographic predictors of deferred definitive therapy and decision for radical prostatectomy (RP) vs. radiotherapy (XRT). Methods: The Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting database was used to identify all FIR PCa diagnosed between 2010 and 2015 opting for AS for at least one year following diagnosis. We sought to determine predictors of treatment and treatment type using multivariable logistic regression. Results: A total of 20 334 patients were identified. An annual decrease in incident FIR patients managed initially with AS between 2010 (4061) and 2015 (2947) was noted (p for trend <0.001); 17 895 (88.0%) patients underwent deferred RP and/or XRT. Patients with higher baseline cancer volume and clinical stage were significantly more likely to discontinue AS. Patients of higher socioeconomic status were more likely to undergo deferred therapy, with increased odds for XRT over RP. African American patients had lower odds of undergoing definitive intervention (odds ratio 0.83, p=0.030) and were significantly more likely to opt for XRT. Oncological characteristics leading to FIR classification influenced treatment choice at the time of deferred intervention: XRT was treatment of choice in 86.3% and 86.0% of Gleason group 2 and PSA 10–20 FIR patients, respectively; 96.1% of treated cT2b-c FIR patients opted for RP. Conclusions: Most FIR PCa patients initially managed with AS eventually undergo deferred definitive therapy, with choice of treatment significantly influenced by patients’ baseline oncological and sociodemographic characteristics.

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Re: Delayed Radical Prostatectomy for Intermediate-Risk Prostate Cancer is Associated with Biochemical Recurrence: Possible Implications for Active Surveillance from the SEARCH Database

The Journal of Urology ◽

10.1016/j.juro.2012.11.131 ◽

2013 ◽

Vol 189 (3) ◽

pp. 900-900

Author(s):

Samir S. Taneja

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Biochemical Recurrence ◽

Intermediate Risk ◽

Risk Prostate Cancer

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Doubling of Decipher Biopsy Genomic Score Is Related to Disease Reclassification on Subsequent Surveillance Biopsy but Not Adverse Features on Radical Prostatectomy

Case Reports in Urology ◽

10.1155/2021/2687416 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Kamyar Ghabili ◽

Nathan Paulson ◽

Jamil S. Syed ◽

Cayce B. Nawaf ◽

Ghazal Khajir ◽

...

Keyword(s):

Radical Prostatectomy ◽

Active Surveillance ◽

Low Risk ◽

Risk Category ◽

Gleason Grade ◽

Grade Group ◽

Group 4 ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Group 2

The utility of serial Decipher biopsy scores in a true active surveillance population is still unknown. In a man on active surveillance for low-risk prostate cancer, a doubling of the Decipher biopsy score within genomic low-risk category from first to the second biopsy related to biopsy reclassification to Gleason grade group 4 on the third biopsy. However, the final pathology at radical prostatectomy showed Gleason grade group 2 with an organ-confined disease. This case suggests that the genomic risk category of Decipher biopsy scores during active surveillance may be more informative than either the interval genomic score change or the biopsy Gleason grade group.

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Tumour growth rates of prostate cancer during active surveillance: is there a difference between MRI-visible low and intermediate-risk disease?

British Journal of Radiology ◽

10.1259/bjr.20210321 ◽

2021 ◽

pp. 20210321

Author(s):

Francesco Giganti ◽

Clare Allen ◽

Vasilis Stavrinides ◽

Armando Stabile ◽

Aiman Haider ◽

...

Keyword(s):

Prostate Cancer ◽

Growth Rate ◽

Active Surveillance ◽

Gleason Grade ◽

Annual Growth Rate ◽

Intermediate Risk ◽

Grade Group ◽

Significant Difference ◽

Group 2 ◽

Group 1

Objectives: The aim of this study was to evaluate the changes in lesion volume on serial multiparametric magnetic resonance (mpMRI) during active surveillance for prostate cancer. Methods: A total of 160 patients with a targeted biopsy-confirmed visible lesion on mpMRI, stratified by low- and intermediate-risk disease (Gleason Grade Group 1 vs Gleason Grade Group 2), were analysed. The % change per year was calculated using the formula: [(final volume/initial volume) exp (1/interval between scans in years)]-1. Results: There was no significant difference in the annual median percentage change between Gleason Grade Group 1 (18%) and Gleason Grade Group 2 (23%) disease (p = 0.16), and between ≤ 10% (23%) and > 10% (22%) of Gleason pattern 4 (p = 0.78). Assuming a spherical lesion, these changes corresponded to annual increases in mean tumour diameter of 6% and 7% for Gleason Grade Group 1 and Gleason Grade Group 2 respectively, which may be less than the interscan variability of serial mpMRI. Conclusion: In an active surveillance cohort, we did not see a significant difference in the annual growth rate of Gleason Grade Group 1 and 2 tumours. Advances in knowledge: In patients on active surveillance, the measured growth rates for visible tumours in Gleason Grade Groups 1 and 2 were similar. The annual growth rate was small in most cases and this may have implications for the MRI follow-up interval in active surveillance.

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Active surveillance in intermediate-risk prostate cancer with PSA 10–20 ng/mL: pathological outcome analysis of a population-level database

Prostate Cancer and Prostatic Diseases ◽

10.1038/s41391-021-00448-8 ◽

2021 ◽

Author(s):

Peter E. Lonergan ◽

Chang Wook Jeong ◽

Samuel L. Washington ◽

Annika Herlemann ◽

Scarlett L. Gomez ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Multivariable Analysis ◽

Specific Antigen ◽

Outcome Analysis ◽

Risk Category ◽

Gleason Grade ◽

Intermediate Risk ◽

Grade Group ◽

Risk Prostate Cancer

Abstract Background Active surveillance (AS) is generally recognized as the preferred option for men with low-risk prostate cancer. Current guidelines use prostate-specific antigen (PSA) of 10–20 ng/mL or low-volume biopsy Gleason grade group (GG) 2 as features that, in part, define the favorable intermediate-risk disease and suggest that AS may be considered for some men in this risk category. Methods We identified 26,548 men initially managed with AS aged <80 years, with clinically localized prostate cancer (cT1-2cN0M0), PSA ≤ 20 ng/mL, biopsy GG ≤ 2 with percent positive cores ≤33% and who converted to treatment with radical prostatectomy from the surveillance, epidemiology, and end results prostate with the watchful waiting database. Multivariable logistic regression was performed to determine predictors of adverse pathology at RP according to PSA level (<10 vs 10–20 ng/mL) and GG (1 vs 2). Results Of 1731 men with GG 1 disease and PSA 10–20 ng/mL, 382 (22.1%) harbored adverse pathology compared to 2340 (28%) of 8,367 men with GG 2 and a PSA < 10 ng/mL who had adverse pathology at RP. On multivariable analysis, the odds of harboring adverse pathology with a PSA 10–20 ng/mL (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.71–2.05, p < 0.001) was less than that of GG 2 (OR 2.56, 95%CI 2.40–2.73, p < 0.001) after adjustment. Conclusions Our results support extending AS criteria more permissively to carefully selected men with PSA 10–20 ng/mL and GG 1 disease.

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