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

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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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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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

Cancer ◽

10.1002/cncr.32709 ◽

2020 ◽

Vol 126 (8) ◽

pp. 1632-1639

Author(s):

Zhuo T. Su ◽

Hiten D. Patel ◽

Jonathan I. Epstein ◽

Christian P. Pavlovich ◽

Mohamad E. Allaf

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Intermediate Risk ◽

Grade Group ◽

Risk Prostate Cancer ◽

Group 2

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Delayed radical prostatectomy for intermediate-risk prostate cancer is associated with biochemical recurrence: Possible implications for active surveillance from the SEARCH database

The Prostate ◽

10.1002/pros.22582 ◽

2012 ◽

Vol 73 (4) ◽

pp. 409-417 ◽

Cited By ~ 49

Author(s):

Michael R. Abern ◽

William J. Aronson ◽

Martha K. Terris ◽

Christopher J. Kane ◽

Joseph C. Presti ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Biochemical Recurrence ◽

Intermediate Risk ◽

Risk Prostate Cancer

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Active surveillance for intermediate‐risk prostate cancer in African American and non‐Hispanic White men

Cancer ◽

10.1002/cncr.33824 ◽

2021 ◽

Author(s):

P. Travis Courtney ◽

Rishi Deka ◽

Nikhil V. Kotha ◽

Daniel R. Cherry ◽

Mia A. Salans ◽

...

Keyword(s):

Prostate Cancer ◽

African American ◽

Active Surveillance ◽

White Men ◽

Intermediate Risk ◽

Risk Prostate Cancer ◽

Hispanic White

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Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽

10.3390/diagnostics11020355 ◽

2021 ◽

Vol 11 (2) ◽

pp. 355

Author(s):

Matteo Ferro ◽

Gennaro Musi ◽

Deliu Victor Matei ◽

Alessandro Francesco Mistretta ◽

Stefano Luzzago ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Active Surveillance ◽

Inflammatory Markers ◽

Low Risk ◽

Inclusion Criteria ◽

Robotic Radical Prostatectomy ◽

Lymphocyte Ratio ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

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