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Prostate Cancer: Localized: Surgical Therapy III (MP50): Moderated Poster 50: Sunday, September 12, 2021

MP50-06 UPGRADING ON RADICAL PROSTATECTOMY SPECIMENS OF VERY LOW- AND LOW-RISK PROSTATE CANCER PATIENTS ON ACTIVE SURVEILLANCE: A POPULATION-LEVEL ANALYSIS

Sayyid, Rashid; Wilson, Brandon; Benton, John; Lodh, Atul; Thomas, Eric; Goldberg, Hanan; Madi, Rabii; Terris, Martha; Wallis, Christopher; Klaassen, Zachary

doi: 10.1097/JU.0000000000002076.06
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INTRODUCTION AND OBJECTIVE:

A proportion of prostate cancer (PCa) patients initially managed with active surveillance (AS) are upgraded to a higher Gleason Score (GS) at the time of radical prostatectomy (RP). Our objective was to determine predictors of upgrading on RP specimens using a national database.

METHODS:

The Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting database was used to identify AS patients diagnosed with very low- or low-risk PCa, managed with AS for at least one year following diagnosis, who subsequently underwent delayed RP between 2010 and 2015. The primary outcome was upgrading to GS 7 disease or worse. Multivariable logistic regression analyses were used to evaluate demographic and oncologic predictors of upgrading on final specimen.

RESULTS:

32,874 men with very low- or low-risk PCa were identified, of whom 3,775 (11.5%) underwent RP during the study period. Median patient age was 60.0 years (IQR 55.0-65.0). 2,774 (73.5%) patients were Caucasian, 2,981 (79.0%) married, 3,548 (94.0%) insured, and 110 (2.9%) covered by Medicaid. 3,541 (93.8%) were clinical stage cT2a. Median PSA and percent positive cores were 4.9 ng/ml (IQR 3.7-6.3) and 15.4% (IQR 8.3%-25.0%), respectively.3,775 men underwent RP after a period of AS, 3,541 (93.8%) of whom were cT2a. 792 (21.0%) patients were upgraded on final RP specimen. 676 (85.4%) were upgraded to GS 7(3+4), 84 (10.6%) to GS 7 (4+3), and 27 (3.4%) to GS 8. There were no cases of upgrading to GS 9 or worse. On multivariable analysis, higher PSA at diagnosis (5-10 vs. 0-2 ng/ml OR: 2.38, p=0.003) and percent core involvement (80-100% vs. 0-20% OR: 3.20, p<0.001) were significant predictors of upgrading on final RP specimen. Higher socioeconomic status was associated with a lower risk of upgrading (highest vs. lowest OR:0.66, p=0.013).

CONCLUSIONS:

Higher baseline PSA and percent positive cores involvement are associated with significantly increased risk of upgrading on RP after AS, whereas higher socioeconomic status predicts lower odds of such events. These results may help identify patients at increased risk of adverse pathology on final specimen who may benefit from earlier definitive treatment.

Source of Funding:

None

© 2021 by American Urological Association Education and Research, Inc.