Do Current Clinical Risk Stratification Models for Intermediate-Risk Prostate Cancer Patients Actually Predict for Unfavorable Pathological Features on Radical Prostatectomy Specimens?

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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172 A new sub-classification system for decision making with intermediate risk prostate cancer patients treated by radical prostatectomy: A multicenter study

European Urology Supplements ◽

10.1016/s1569-9056(16)60174-4 ◽

2016 ◽

Vol 15 (3) ◽

pp. e172

Author(s):

J.B. Beauval ◽

G. Ploussard ◽

A. Ouzzane ◽

A. Gougeon ◽

B. Cabarrou ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Multicenter Study ◽

Classification System ◽

Intermediate Risk ◽

Risk Prostate Cancer

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Intraductal carcinoma of the prostate in prostate biopsy samples: Correlation with pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.123 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 123-123

Author(s):

Sha Zhu

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Cancer Patients ◽

Prostate Biopsy ◽

Prognostic Value ◽

Pathological Features ◽

Carcinoma Of The Prostate ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

123 Background: Intraductal carcinoma of the prostate (IDC-P) is a biologically aggressive form of prostate cancer. We investigated the correlation between IDC-P in prostate biopsy samples (Pbx) and several pathological features after radical prostatectomy (RP), also its prognostic value in high-risk prostate cancer patients. Methods: Totally, 455 patients diagnosed with PCa during 2010 to 2017 in West China Hospital were included in this study. Chi-squared test and binary logistic regression were used in discovering the correlation between IDC-P and post-RP pathological features. Kaplan Meier curve, log-rank test, Cox’s proportional hazards model and C-index were applied in the investigation of the prognostic value of IDC-P on 418 high-risk patients. Results: The detection rate of IDC-P in Pbx is 7.91%. IDC-P was an independent predictor of SVI ( p= 0.014), EPE ( p< 0.001), cT stage ( p= 0.001), PSM of urethra end ( p= 0.042). Patients with IDC-P in PBx specimens manifested poorer BFS than those without IDC-P ( p< 0.001), and IDC-P pattern 2 (HR: 4.429, p= 0.020) was associated with worse prognosis than IDC-P pattern 1 (HR: 3.225, p= 0.047). Further analyses also demonstrated that the addition of IDC-P in several nomograms could improve their C-index. Conclusions: IDC-P is associated with several post-RP pathological features after radical prostatectomy. Also, IDC-P can effectively predict the patients’ BFS, and the addition of it can increase the C-index of several nomograms.

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