ACS 2018: Evaluation of a Predefined Active Surveillance Threshold in a Large Cohort of Men with Localized Prostate Cancer

Boston, Massachusetts ( Daniel J. Canter, MD evaluated the performance of the AS threshold in a contemporary cohort of men with newly diagnosed localized prostate cancer. Men with localized prostate cancer historically select active surveillance (AS) using clinicopathologic features. However, a clinical cell−cycle risk (CCR) score has been developed including both molecular [cell cycle progression (CCP)] and clinical [Cancer of the Prostate Risk Assessment (CAPRA)] features.

A CCR threshold score has been developed and validated to identify men with low-risk disease who may be candidates for AS. They performed a retrospective cohort study among men with localized prostate cancer who were treated at the Ochsner Clinic between 2006 and 2011 were evaluated. CCP testing was performed, and a CCP score was determined from the RNA expression of 31 CCP genes and 15 housekeeping genes. The CCR score was calculated as (0. 57xCCP) + (0. 39xCAPRA). A CCR score threshold of 0. 8 has been previously validated in a cohort of men.

Among 217 men had CCR scores ≤ 0. 8. Of these, 125 were treated by radical prostatectomy, 61 with radiation, 2 with radiation and hormones, 2 with hormones only, and 19 with watchful waiting. Treatment for eight men was unknown. One patient (0. 5%) with a CCR score below the AS threshold progressed to metastatic disease.

In conclusion, they evaluated the performance of a previously validated AS threshold on a contemporary US cohort. Although the majority of the patients in this study were treated, the observed metastatic event rate of 0. 5% supports the CCR threshold as safe to identify candidates for AS. Further determination of clinical utility in a larger number of patients and balancing high value-based care (outcomes/cost) are needed.

Presented By: Daniel J. Canter, MD, Ochsner Clinic, New Orleans, Louisiana

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts