PURPOSE: To report the percentage of patients on active surveillance who were pathologically upgraded and factors that predict for upgrading on surveillance biopsies.
MATERIALS AND METHODS: Patients in our AS database with at least one repeat prostate biopsy were included. Histological upgrading was defined as any increase in primary or secondary Gleason grade on repeat biopsy. Multivariate analysis was used to determine baseline and dynamic factors associated with Gleason upgrading. This information was used to develop a nomogram to predict for upgrading or treatment in patients electing for AS.
RESULTS: 592 of 862 patients in our cohort had > 2 biopsies. Median follow-up was 6.4 years. Twenty percent of patients were intermediate risk, 0.3% high risk, all others low risk. During AS, 31.3% of patients were upgraded. On multivariate analysis, clinical stage T2, higher PSA and higher percentage cores involved with disease at the time of diagnosis predicted for upgrading. 27 patients (15% of those upgraded) were Gleason 8 or higher at upgrading. 62% of upgraded patients (n=114) went on to have active treatment. The nomogram incorporated clinical stage, age, PSA, core positivity and Gleason score. The concordance index was 0.61.
CONCLUSIONS: In this large re-biopsy cohort with medium-term follow-up, most patients have not been pathologically upgraded to date. A model predicting for upgrading or radical treatment was developed which could be useful in counseling patients considering AS for prostate cancer.
Jain S, Loblaw A, Vesprini D, Zhang L, Kattan MW, Mamedov A, Jethava V, Sethukavalan P, Yu C, Klotz L. Are you the author?
Department of Radiation Oncology; Centre for Cancer Research and Cell Biology, Queen's University Belfast; Department of Radiation Oncology; Institute of Health Policy, Measurement and Evaluation; Odette Cancer Centre, Sunnybrook Health Sciences Centre; Department of Radiation Oncology; Odette Cancer Centre, Sunnybrook Health Sciences Centre; Department of Quantitative Health Sciences, Cleveland Clinic; Division of Urology, Department of Surgery, University of Toronto; Odette Cancer Centre, Sunnybrook Health Sciences Centre.
Reference: J Urol. 2015 Feb 4. pii: S0022-5347(15)00213-X.