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EAU 2018

EAU 2018: How Can We Expand Active Surveillance Criteria in Patients with Low- and Intermediate Risk Prostate Cancer without Increasing the Risk of Misclassification: Development of a Novel Risk Calculator

Copenhagen, Denmark (UroToday.com)  The risk of unfavorable pathological features (i.e., misclassification) is not negligible in active surveillance (AS) candidates undergoing radical prostatectomy (RP). The authors aimed to develop a novel tool to increase the number of prostate cancer (PCa) patients eligible for AS without increasing the risk of misclassification.

Overall, 16,049 patients with low- or intermediate risk PCa treated with RP were identified. Misclassification was defined as non-organ confined or grade group ≥3 disease at RP. The coefficients of a logistic regression model predicting classification were used to develop a risk score. Furthermore, a systematic analysis of different cut-offs to discriminate between patients with or without unfavorable disease was performed and was compared to available AS criteria.

Overall, 5,289 (33.0%) patients had unfavorable disease. At multivariable analyses all the following were associated with the risk of unfavorable disease (all P<0.001):

  1. PSA (Odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.11-1.13) 
  2. Clinical stage T2 (OR: 2.27; 95%CI: 2.10-2.46) 
  3. Biopsy grade group 2 (OR: 2.66; 95%CI: 2.46-2.87) 
  4. Biopsy grade group 3 (OR: 7.21; 95%CI: 6.5-7.9) 
  5. The number of positive cores (OR: 1.10; 95%CI: 1.09-1.11) 
  6. PSA density (OR: 1.20; 95%CI: 1.15-1.25) 
The Prostate Cancer Research International: AS (PRIAS) criteria were associated with a lower risk of misclassifications (13%) compared to other criteria. Overall, 3,303 (20.6%) patients were eligible according to the PRIAS protocol. The adoption of an 18% cut-off according to the risk score, increased the proportion of eligible patients from 20.6 to 29.4% without increasing the risk of misclassification as compared to the PRIAS criteria.

Approximately 13% of patients potentially eligible for AS according to the PRIAS protocol, who will undergo RP, will ultimately harbor unfavorable disease characteristics at final pathology. The use of a novel risk score for the selection of men who should be included in AS protocols would result in a 50% increase in the number of patients potentially eligible for this approach. This occurs without increasing the risk of adverse pathological outcomes.


Presented by: Gandaglia G, San Raffaele Hospital, Dept. of Urology, Milan, Italy

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