SUO 2017: Utilization of MRI and Genomic Markers in Surveillance and Treatment Selection Among Patients Diagnosed With Prostate Cancer

Washington, DC ( Introduction: Contemporary assessment tools for patients with prostate cancer (PCa) include genomic marker testing, and multiparametric magnetic resonance imaging (mp−MRI). The purpose of this study was to assess the utilization of these clinical assessments in the management of NCCN very low to intermediate risk prostate cancer with active surveillance (AS) or primary intervention (radical prostatectomy or radiotherapy).

Methods: The records of men diagnosed with NCCN very low to intermediate risk PCa from a single center between January 2013 and September 2016 with Oncotype Dx were reviewed. Multivariable logistic regression model was used to assess participation in an AS protocol or primary intervention protocol.

Results: A total of 389 men were identified. Patients who selected an AS protocol (235, 60%) or primary intervention (154, 40%) were followed for median of 19 (IQR: 11−31) months. Median age at diagnosis was 64 years (IQR: 59−69). In addition to standard trans-rectal ultrasound (TRUS) biopsy, 217 (56%) men received MRI/TRUS fusion biopsy. On multivariable logistic regression, a higher genomic prostate score (favorable pathology) correlated with increased participation in an AS protocol (HR 1.05, p= 0.002); while an increased number of lesions found on mp−MRI (OR: 0.57, p = 0.012), and higher PSA level at presentation (OR: 0.82, p = 0.001), correlated with less participation in an AS protocol.

Conclusion: In this single center study, both Oncotype Dx score and mp−MRI lesions correlated with the shared decision to participate in an AS protocol.

Speaker: Nitin K. Yerram, Cleveland OH, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC