A novel predictor of clinical progression in patients on active surveillance for prostate cancer

Guan Hee Tan, Antonio Finelli, Ardalan Ahmad, Marian S. Wettstein, Thenappan Chandrasekar, Alexandre R. Zlotta, Neil E. Fleshner, Robert J. Hamilton, Girish S. Kulkarni, Khaled Ajib, Gregory Nason, Nathan Perlis

Research output: Contribution to journalArticle

Abstract

Introduction: Active surveillance (AS) is standard of care in low-risk prostate cancer (PCa). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP). Methods: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years followup. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo/prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival (PFS) curves between TCLo density groups. Test characteristics of TCLo density were explored with receiver operating characteristic (ROC) curves. Results: We included 181 patients who had CBx from 2012‒2015 and met inclusion criteria. The mean age of patients was 62.58 years (standard deviation [SD] 7.13) and median followup was 60.9 months (interquartile range [IQR] 23.4). A high TCLo density score (>0.05) was independently associated with time to CP (hazard ratio [HR] 4.70; 95% confidence interval [CI] 2.62‒8.42; p<0.001) and GP (HR 3.85; 95% CI 1.91‒7.73; p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression. Conclusions: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PCa.

Original languageEnglish
Pages (from-to)250-255
Number of pages6
JournalCanadian Urological Association Journal
Volume13
Issue number8
DOIs
Publication statusPublished - 1 Jan 2019

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Prostatic Neoplasms
Confidence Intervals
Neoplasms
Standard of Care
ROC Curve
Area Under Curve
Decision Making
Retrospective Studies
Biopsy

ASJC Scopus subject areas

  • Urology

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Tan, G. H., Finelli, A., Ahmad, A., Wettstein, M. S., Chandrasekar, T., Zlotta, A. R., ... Perlis, N. (2019). A novel predictor of clinical progression in patients on active surveillance for prostate cancer. Canadian Urological Association Journal, 13(8), 250-255. https://doi.org/10.5489/cuaj.6122

A novel predictor of clinical progression in patients on active surveillance for prostate cancer. / Tan, Guan Hee; Finelli, Antonio; Ahmad, Ardalan; Wettstein, Marian S.; Chandrasekar, Thenappan; Zlotta, Alexandre R.; Fleshner, Neil E.; Hamilton, Robert J.; Kulkarni, Girish S.; Ajib, Khaled; Nason, Gregory; Perlis, Nathan.

In: Canadian Urological Association Journal, Vol. 13, No. 8, 01.01.2019, p. 250-255.

Research output: Contribution to journalArticle

Tan, GH, Finelli, A, Ahmad, A, Wettstein, MS, Chandrasekar, T, Zlotta, AR, Fleshner, NE, Hamilton, RJ, Kulkarni, GS, Ajib, K, Nason, G & Perlis, N 2019, 'A novel predictor of clinical progression in patients on active surveillance for prostate cancer', Canadian Urological Association Journal, vol. 13, no. 8, pp. 250-255. https://doi.org/10.5489/cuaj.6122
Tan, Guan Hee ; Finelli, Antonio ; Ahmad, Ardalan ; Wettstein, Marian S. ; Chandrasekar, Thenappan ; Zlotta, Alexandre R. ; Fleshner, Neil E. ; Hamilton, Robert J. ; Kulkarni, Girish S. ; Ajib, Khaled ; Nason, Gregory ; Perlis, Nathan. / A novel predictor of clinical progression in patients on active surveillance for prostate cancer. In: Canadian Urological Association Journal. 2019 ; Vol. 13, No. 8. pp. 250-255.
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AU - Finelli, Antonio

AU - Ahmad, Ardalan

AU - Wettstein, Marian S.

AU - Chandrasekar, Thenappan

AU - Zlotta, Alexandre R.

AU - Fleshner, Neil E.

AU - Hamilton, Robert J.

AU - Kulkarni, Girish S.

AU - Ajib, Khaled

AU - Nason, Gregory

AU - Perlis, Nathan

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N2 - Introduction: Active surveillance (AS) is standard of care in low-risk prostate cancer (PCa). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP). Methods: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years followup. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo/prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival (PFS) curves between TCLo density groups. Test characteristics of TCLo density were explored with receiver operating characteristic (ROC) curves. Results: We included 181 patients who had CBx from 2012‒2015 and met inclusion criteria. The mean age of patients was 62.58 years (standard deviation [SD] 7.13) and median followup was 60.9 months (interquartile range [IQR] 23.4). A high TCLo density score (>0.05) was independently associated with time to CP (hazard ratio [HR] 4.70; 95% confidence interval [CI] 2.62‒8.42; p<0.001) and GP (HR 3.85; 95% CI 1.91‒7.73; p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression. Conclusions: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PCa.

AB - Introduction: Active surveillance (AS) is standard of care in low-risk prostate cancer (PCa). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP). Methods: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years followup. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo/prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival (PFS) curves between TCLo density groups. Test characteristics of TCLo density were explored with receiver operating characteristic (ROC) curves. Results: We included 181 patients who had CBx from 2012‒2015 and met inclusion criteria. The mean age of patients was 62.58 years (standard deviation [SD] 7.13) and median followup was 60.9 months (interquartile range [IQR] 23.4). A high TCLo density score (>0.05) was independently associated with time to CP (hazard ratio [HR] 4.70; 95% confidence interval [CI] 2.62‒8.42; p<0.001) and GP (HR 3.85; 95% CI 1.91‒7.73; p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression. Conclusions: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PCa.

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