Abstract
Objectives
To determine if older men with Gleason grade group (GG) 1 prostate cancer have a higher
risk of having adverse pathology at radical prostatectomy after initially being managed
with active surveillance (AS).
Methods
A total of 365 patients with GG1 prostate cancer initially managed with AS followed
by delayed radical prostatectomy were identified. The primary outcome was adverse
pathology after delayed radical prostatectomy in the men that were <65 years vs. men
≥65 years at the initiation of AS. Adverse pathology was defined as GG ≥3 or pT3 or
pN1. Multivariable Cox proportional hazards regression models were used to calculate
risk of adverse pathological findings at radical prostatectomy by age group.
Results
At diagnosis, there were no significant differences in median prostate specific antigen
density, percent positive biopsy cores, multiparametric magnetic resonance imaging
(mpMRI) results or composite genomic classifier scores (derived from three commercially
available genomic tests) between the two age groups. Men ≥65 years had more adverse
pathology at radical prostatectomy (59.2% vs. 44.1%, P <0.01) and lower rates of biopsy upgrade-free survival and adverse pathology-free
survival (log-rank P <0.01). On multivariable analysis age ≥65 years (Hazard Ratio (HR) 2.21, 95% Confidence
Interval (CI) 1.57, 3.12) was associated with adverse pathology at radical prostatectomy.
In separate multivariable analyses done for each age group, mpMRI (HR 3.33, 95% CI
1.01, 10.95) was predictor of adverse pathology in the group ≥65 years.
Conclusion
Older patients might require closer monitoring on AS and additional testing such as
mpMRI might improve their risk stratification.
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References
- NCCN Guidelines Version 1.2020.Prostate Cancer. 2020;
- Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.J Clin Oncol. 2015; 33: 272
- 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.N Engl J Med. 2016; 375: 1415
- Older Age Predicts Biopsy and Radical Prostatectomy Grade Reclassification to Aggressive Prostate Cancer in Men on Active Surveillance.J Urol. 2019; 201: 98
- Active Surveillance in Younger Men With Prostate Cancer.J Clin Oncol. 2017; 35: 1898
- Association of Age With Risk of Adverse Pathological Findings at Radical Prostatectomy in Men With Gleason Score 6 Prostate Cancer.JAMA Netw Open. 2020; 3e202041
- Active surveillance for prostate cancer: current evidence and contemporary state of practice.Nat Rev Urol. 2016; 13: 205
- Medium-term outcomes of active surveillance for localised prostate cancer.Eur Urol. 2013; 64: 981
- High-grade prostate cancer is associated with low serum testosterone levels.Prostate. 2001; 47: 52
- Epigenetic susceptibility factors for prostate cancer with aging.Prostate. 2013; 73: 1721
- Multifocal Primary Prostate Cancer Exhibits High Degree of Genomic Heterogeneity.Eur Urol. 2019; 75: 498
- MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis.N Engl J Med. 2020; 382: 917
- Clinical-genomic Characterization Unveils More Aggressive Disease Features in Elderly Prostate Cancer Patients with Low-grade Disease.Eur Urol Focus. 2020;
- Oncological outcomes after robot-assisted radical prostatectomy: long-term follow-up in 4803 patients.BJU Int. 2014; 114: 824
- Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up.Eur Urol. 2010; 58: 838
- Lymph node-positive prostate cancer after robotic prostatectomy and extended pelvic lymphadenectomy.J Robot Surg. 2018; 12: 425
Article info
Publication history
Published online: June 09, 2021
Accepted:
May 26,
2021
Received:
February 2,
2021
Footnotes
Funding Support: This study was funded by the UCSF Goldberg-Benioff Program in Cancer Translational Biology.
Data integrity / accuracy, availability of data, material and code: Senior author Dr. Carroll had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Data, code and analysis available upon request.
Declaration of interest: none.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
