Disease reclassification risk with stringent criteria and frequent monitoring in men with favourable-risk prostate cancer undergoing active surveillance

OBJECTIVE - To determine the frequency of disease reclassification and to identify clinicopathological variables associated with it in patients with favourable-risk prostate cancer undergoing active surveillance (AS).

METHODS - We assessed 191 men, selected by what may be the most stringent criteria used in AS studies yet conducted, who were enrolled in a prospective cohort AS trial. Clinicopathological characteristics were analysed in a multivariate Cox proportional hazards regression model. Key features were an extended biopsy with a single core positive for Gleason score (GS) 3 + 3 (

RESULTS - Disease was reclassified in 32 patients (16.8%) including upgrading to GS 4 + 3 in five patients (2.6%). The median (interquartile range) follow-up time among survivors was 3 (1.9-4.6) years. Overall, 13 of the 32 (40.6%) had incremental increases in GS. Tumour length (hazard ratio 2.95, 95% confidence interval [CI] 1.34-6.46; P = 0.007) and older age (hazard ratio 1.05, 95% CI 1.00-1.09; P = 0.05) were identified as significant and marginally significant predictors of disease reclassification, respectively. Disease remained stable in 83.2% of patients.

CONCLUSIONS - The need persists for improvements in risk stratification and predictive indicators of cancer progression.

BJU Int. 2015 Jun 8. doi: 10.1111/bju.13193. [Epub ahead of print]

Davis JW1, Ward JF 3rd1, Pettaway CA1, Wang X2, Kuban D3, Frank SJ3, Lee AK3, Pisters LL1, Matin SF1, Shah JB1, Karam JA1, Chapin BF1, Papadopoulos JN1, Achim M1, Hoffman KE3, Pugh TJ3, Choi S3, Troncoso P4, Logothetis CJ5, Kim J5.

1 Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
2 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
3 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4 Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
5 Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

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