Giorgio Gandaglia1, Roderick C N van den Bergh2, Derya Tilki3,4, Nicola Fossati1, Piet Ost5, Christian I Surcel6, Prasanna Sooriakumaran7, Igor Tsaur8, Massimo Valerio9, Alexander Kretschmer10, Emanuele Zaffuto1, Laurent Salomon11, Francesco Montorsi1,12, Markus Graefen3, Henk van der Poel2, Alexandre de la Taille11, Alberto Briganti1,12, Guillaume Ploussard11,13. 1. Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. 2. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 3. Martini-Klinik Prostate Cancer Center, University-Hospital Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Urology, University-Hospital Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium. 6. Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania. 7. Department of Uro-oncology, University College London Hospital, London, UK. 8. Department of Urology, University Medicine Mainz, Mainz, Germany. 9. Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 10. Urologische Klinik und Poliklinik, Campus Großhadern, Ludwig-Maximilians-Universität, Munich, Germany. 11. Department of Urology, Henri Mondor Hospital, Assistance-Publique Hopitaux de Paris, Creteil, France. 12. Vita-Salute San Raffaele University, Milan, Italy. 13. Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France.
Abstract
OBJECTIVE: To develop a novel tool to increase the number of patients with prostate cancer eligible for active surveillance (AS) without increasing the risk of unfavourable pathological features (i.e., misclassification) at radical prostatectomy (RP). PATIENTS AND METHODS: Overall, 16 049 patients with low- or intermediate-risk prostate cancer treated with RP were identified. Misclassification was defined as non-organ confined or grade group ≥3 disease at RP. The coefficients of a logistic regression model predicting misclassification were used to develop a risk score. We then performed a systematic analysis of different thresholds to discriminate between patients with or without unfavourable disease and we compared it to available AS criteria. RESULTS: Overall, 5289 (33.0%) patients had unfavourable disease. At multivariable analyses, PSA level, clinical stage, biopsy grade group, the number of positive cores, and PSA density were associated with the risk of unfavourable disease (all P < 0.001). The Prostate Cancer Research International: Active Surveillance (PRIAS) criteria were associated with a lower risk of misclassification (13%) compared to other criteria. Overall, 3303 (20.6%) patients were eligible according to the PRIAS protocol. The adoption of an 18% threshold according to the risk score increased the proportion of eligible patients from 20.6% to 29.4% without increasing the risk of misclassification as compared to the PRIAS criteria. CONCLUSIONS: The use of a novel risk score for AS selection would result in an absolute increase of 10% in the number of patients eligible for this approach without increasing the risk of misclassification.
OBJECTIVE: To develop a novel tool to increase the number of patients with prostate cancer eligible for active surveillance (AS) without increasing the risk of unfavourable pathological features (i.e., misclassification) at radical prostatectomy (RP). PATIENTS AND METHODS: Overall, 16 049 patients with low- or intermediate-risk prostate cancer treated with RP were identified. Misclassification was defined as non-organ confined or grade group ≥3 disease at RP. The coefficients of a logistic regression model predicting misclassification were used to develop a risk score. We then performed a systematic analysis of different thresholds to discriminate between patients with or without unfavourable disease and we compared it to available AS criteria. RESULTS: Overall, 5289 (33.0%) patients had unfavourable disease. At multivariable analyses, PSA level, clinical stage, biopsy grade group, the number of positive cores, and PSA density were associated with the risk of unfavourable disease (all P < 0.001). The Prostate Cancer Research International: Active Surveillance (PRIAS) criteria were associated with a lower risk of misclassification (13%) compared to other criteria. Overall, 3303 (20.6%) patients were eligible according to the PRIAS protocol. The adoption of an 18% threshold according to the risk score increased the proportion of eligible patients from 20.6% to 29.4% without increasing the risk of misclassification as compared to the PRIAS criteria. CONCLUSIONS: The use of a novel risk score for AS selection would result in an absolute increase of 10% in the number of patients eligible for this approach without increasing the risk of misclassification.
Authors: Rocco S Flammia; Benedikt Hoeh; Lukas Hohenhorst; Gabriele Sorce; Francesco Chierigo; Andrea Panunzio; Zhe Tian; Fred Saad; Costantino Leonardo; Alberto Briganti; Alessandro Antonelli; Carlo Terrone; Shahrokh F Shariat; Umberto Anceschi; Markus Graefen; Felix K H Chun; Francesco Montorsi; Michele Gallucci; Pierre I Karakiewicz Journal: Int Urol Nephrol Date: 2022-07-15 Impact factor: 2.266