Validating the total cancer location density metric for stratifying patients with low-risk localized prostate cancer at higher risk of grade group reclassification while on active surveillance.

Tan, Guan Hee; Deniffel, Dominik; Finelli, Antonio; Wettstein, Marian; Ahmad, Ardalan; Zlotta, Alexandre; Fleshner, Neil; Hamilton, Robert; Kulkarni, Girish; Nason, Gregory; Ajib, Khaled; Herrera-Caceres, Jaime; Chandrasekar, Thenappan; Perlis, Nathan

doi:10.1016/j.urolonc.2022.12.003

Clinical Medicine

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Dokumenttyp:: Journal Article
Autor(en):: Tan, Guan Hee; Deniffel, Dominik; Finelli, Antonio; Wettstein, Marian; Ahmad, Ardalan; Zlotta, Alexandre; Fleshner, Neil; Hamilton, Robert; Kulkarni, Girish; Nason, Gregory; Ajib, Khaled; Herrera-Caceres, Jaime; Chandrasekar, Thenappan; Perlis, Nathan
Titel:: Validating the total cancer location density metric for stratifying patients with low-risk localized prostate cancer at higher risk of grade group reclassification while on active surveillance.
Abstract:: PURPOSE: To validate a previously proposed prognostic metric, Total Cancer Location (TCLo) density, in a contemporary cohort of men with grade group (GG) 1 prostate cancer (PCa) on active surveillance (AS). METHODS: We evaluated 123 patients who entered AS with maximum GG1 PCa at diagnostic and/or confirmatory biopsy. TCLo was defined as the total number of PCa locations identified on both biopsy sessions. TCLo density was calculated as TCLo / prostate volume [ml]. Primary endpoint was progression-free survival (PFS), defined as time from confirmatory biopsy to grade group reclassification (GGR) on repeat biopsy or prostatectomy. Optimal cut-point for TCLo density was predefined in a previously reported cohort and applied to this contemporary cohort. Kaplan-Meier and multivariable Cox regression analysis were used to estimate the association of predictors with PFS. RESULTS: During median follow-up of 7.8 years, (IQR 7.3-8.2) 34 men had GGR. Using previously defined cut-points, PFS at 5-years was 60% (95% CI: 44%-81%) vs. 89% (95% CI: 83%-96%) in men with high (≥0.06 ml-1) vs. low (<0.06 ml-1) TCLo density, and 63% (95% CI: 48%-82%) vs. 90% (95% CI: 83%-96%) in men with high (≥3) vs. low (≤2) TCLo (log-rank test: P < 0.0001, respectively). Adjusting for age, prostate volume, percent of positive cores and PSA, both higher TCLo density (HR [per 0.01 ml-1 increase]: 1.18, 95% CI: 1.05-1.33, P = 0.005) and TCLo (HR: 1.69, 95% CI: 1.20-2.38, P = 0.002) were associated with shorter PFS. CONCLUSION: The previously suggested prognostic value of TCLo density was confirmed in this validation cohort. TCLo alone performed similarly well. Patients with high TCLo density (≥0.06 ml-1) or TCLo (>2) were at greater risk of GGR while on AS. With external validation, these metric may help guide risk-adapted surveillance protocols.
Zeitschriftentitel:: Urol Oncol
Jahr:: 2023
Band / Volume:: 41
Heft / Issue:: 3
Seitenangaben Beitrag:: 146.e23-146.e28
Volltext / DOI:: doi:10.1016/j.urolonc.2022.12.003
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/36639336
Print-ISSN:: 1078-1439
TUM Einrichtung:: Institut für Diagnostische und Interventionelle Radiologie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Institut für Diagnostische und Interventionelle Radiologie (Prof. Makowski)2023