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Title: Patients not suitable for active surveillance but in whom Gleason upgrading could be excluded have biochemical recurrence rates similarly favourable to patients who are suitable for active surveillance.
Epworth Authors: Van den Bergh, Roderick
Murphy, Declan
Keywords: Prostate Cancer
Biochemical Recurrence Rates
Active Surveillance
Biopsy Grading
Gleason Score
Prostatic Neoplasms
Guided Biopsy
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth Prostate Centre, Epworth Healthcare, Victoria, Australia.
Issue Date: Jul-2016
Citation: Research Week 2016, Poster 49, pp75.
Conference Name: Epworth Research Institute, Research Week 2016
Conference Location: Epworth HealthCare, Richmond, Victoria, 3121, Australia.
Abstract: Introduction/ background: Novel prostate imaging techniques with MRI in combination with guided biopsy aim to reduce Gleason score under grading. We compared biochemical recurrence rates (BCR) after radical prostatectomy between patients with active surveillance (AS) suitable prostate cancer versus wider defined low risk prostate cancer and the effect of Gleason score upgrading after surgery. Method: Two prostatectomy cohorts were combined. Low-risk PC was defined as T1-2, Gleason 6 prostate cancer and AS-suitable prostate cancer was defined using the 'PRIAS-criteria' as T1-2, PSA =<10 ng/ml, PSA density <0.2 ng/ml/ml, 1-2 positive biopsies, Gleason 3+3=6. Kaplan-Meirer curves of patients with and without Gleason score upgrading were compared using the log-Rank test. We hypothesized that perfect pre-operative biopsy Gleason grading would lead to 0% upgrading after surgery. Results: We included 755 patients; 181 (24%) suitable for AS, 324 (44%) had Gleason upgrading after surgery (to 6.5 in non-AS suitable versus 6.3; p=0.005), and 132 (18%) showed BCR a median of 1.0 year prostatectomy. For the total group, the 5-year BCR rate was 27%. Regrading the entire low risk group of T1-2 Gleason 6 prostate cancer, Gleason upgrading at surgery was significantly associated with unfavourable BCR rates (Figure 1a; p<0.01). Within the selected group of more favourable risk disease suitable for AS, Gleason upgrading at surgery was not associated with BCR rates (Figure 1B; p+0.936). In patients who did not have Gleason upgrading, patients who were not suitable for AS showed BCR rates to patients who did fulfil ass AS criteria (Figure 1c; p=0.155). A limitation is the retrospective design; prospective validation is needed. Conclusion: These results may question the additional value of reducing biopsy under grading with new imaging techniques in AS-suitable patients. Also, novel imaging such as MRI could be used to expand selection criteria for AS if Gleason upgrading could be excluded.
Type: Conference Poster
Affiliated Organisations: Peter MacCallum Cancer Centre, Melbourne, Australia
Royal Melbourne Hospital, Parkville, Victoria, Australia.
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:Cancer Services
Research Month

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