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EAU 2018

EAU 2018: Defining a Favorable Intermediate-Risk Group: Utility of Magnetic Resonance Imaging and Genetic Tests

Copenhagen, Denmark (UroToday.com) Active surveillance (AS) is an appropriate treatment strategy in very low risk (VLR) or low risk (LR) prostate cancer (PCa). Recently, intermediate risk patients with favorable pathology (FIR) have been reported of being placed on AS; however, there is no consensus on what constitutes FIR. The authors sought to determine whether MRI and genetic biomarkers can provide additional information to help define the FIR risk category.

The authors retrospectively identified 502 patients who underwent radical prostatectomy at their institution from October 2013 to August 2017. Every patient received pre-operative MRI and post-biopsy Decipher test (GenomeDx Biosciences). LR, FIR, unfavorable intermediate risk (UIR) and high risk (HR) categories were defined as PSA >=20 ng/ml or Gleason score 4-5 or clinical stage >T3, respectively. Adverse pathologic findings within the AUA risk groups were calculated and univariable and multivariable logistic regression analyses were performed to identify predictors of adverse pathologic findings within the FIR and UIR patients.

The authors found that 55 (11%), 155 (30.9%), 139 (27.6%) and 153 (30.5%) of patients fell within the LR, FIR, UIR and HR categories, respectively. The risk of adverse pathologic findings among UIR patients (46%) was notably higher than risk of adverse pathologic findings among LR (11%) or FIR patients (12.9%). Univariable logistic regression analysis showed that PSA, AUA risk category (FIR vs UIR), Gleason score, Extracapsular extension (EXE) on MRI, and Decipher test can be used to predict adverse pathologic findings at radical prostatectomy. These variables were used to construct a binary multivariable logistic regression model that predicts adverse pathology within FIR and UIR groups.

In summary, preoperative mpMRI and Decipher test on biopsy specimens can be used to expand AS criteria including men with FIR, no MRI ECE and low risk or average risk.


Presented by: Falagario U.G, Mount Sinai Hospital, Dept. of Urology, New York, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark