Aureon’s pre-treatment prostate cancer risk assessment system is the Prostate Px+, which uses the patient’s PNB specimen and 8-year median outcome data post radical prostatectomy. They sought to determine the performance of these disease progression models on predicting which patients enrolled in an AS program are most likely to remain on AS or be treated, by evaluating predictors of disease progression including subsequent biopsy Gleason grade (GG) upgrading and time from AS enrollment to definitive treatment. They evaluated 100 AS patients with the following characteristics; median age 71 years, 92% cT1-T2a, 85% <=GS6, median PSA 6.2 ng/mL. The patients had 8-year median follow up and available diagnostic PNB specimens evaluated with the systems pathology platform. Disease progression models predicting either GG upgrading on a subsequent biopsy or time to definitive treatment were evaluated. The AUC/concordance index (CI), PPV, NPV, and hazard ratio with p-value were used to assess models performance.
Utilizing existing model thresholds now applied to clinical endpoints of upgrading and treatment, the Prostate Px+ models were able to accurately identify which AS patients were most likely to not have a Gleason upgrade on a subsequent biopsy (AUC 0.73, NPV 0.86, PPV 0.60). They were also able to predict which patients were at risk for requiring therapy while on AS (hazard ratio 3.4, p=0.006). The correlation of Gleason rise with treatment had a chi-square of 16.45, p<0.001.
Presented by Michael Donovan, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.