Current European Association of Urology, American Urological Association, and National Comprehensive Cancer Network guidelines recommend active surveillance (AS) for selected intermediate-risk prostate cancer (PCa) patients. However, limited evidence exists regarding which men can be selected safely.
To externally validate the Gandaglia risk calculator (Gandaglia-RC), designed to predict adverse pathology (AP) at radical prostatectomy (RP) and thus able to improve selection of intermediate-risk PCa patients suitable for AS, and to assess whether addition of magnetic resonance imaging (MRI) findings (MAP model) improves the predictive ability of Gandaglia-RC.
This is a retrospective analysis of a single-center cohort of 1284 consecutive men with low- and intermediate-risk PCa treated with RP between 2013 and 2019.
AP was defined as non-organ-confined disease and/or lymph node invasion and/or pathological grade group≥3 at RP. Logistic regression was used to calculate the predictors of AP; calculated coefficients were used to develop a risk score. Receiver operating characteristic curve analysis and decision curve analysis were performed to evaluate the net benefit within models.
At multivariable analysis, age at surgery, prostate-specific antigen, systematic and targeted biopsy Gleason grade group, MRI prostate volume, Prostate Imaging Reporting and Data System score, and MRI extraprostatic extension were significantly associated with AP. The model significantly improved the ability of Gandaglia-RC to predict AP (area under the curve 0.71 vs 0.63 [p<0.0001]). Using a 30% threshold, the proportions of men eligible for AS were 45% and 77% and the risks of AP were 16% and 17%, for Gandaglia-RC and MAP model, respectively.
Compared with Gandaglia-RC, the MAP model significantly increased the number of patients eligible for AS without significantly increasing the risk of AP at RP.
In this report, we have developed a risk prediction tool to select men for conservative treatment of prostate cancer. Using the novel tool, more men could safely be allocated to conservative treatment rather than surgery or radiation.
European urology oncology. 2020 Sep 02 [Epub ahead of print]
Anna Lantz, Ugo Giovanni Falagario, Parita Ratnani, Ivan Jambor, Zach Dovey, Alberto Martini, Sara Lewis, Dara Lundon, Sujit Nair, Deron Phillip, Kenneth Haines, Luigi Cormio, Giuseppe Carrieri, Natasha Kryprianou, Ash Tewari
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital Solna, Sweden. Electronic address: ., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, University of Turku, Turku, Finland., Department of Urology, Vita-Salute San Raffaele University, Milan, Italy., Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy., Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.