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• W2071688954 abstract "No AccessJournal of UrologyAdult Urology1 Jul 2015Gleason Upgrading with Time in a Large Prostate Cancer Active Surveillance Cohort Suneil Jain, Andrew Loblaw, Danny Vesprini, Liying Zhang, Michael W. Kattan, Alexandre Mamedov, Vibhuti Jethava, Perakaa Sethukavalan, Changhong Yu, and Laurence Klotz Suneil JainSuneil Jain Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom More articles by this author , Andrew LoblawAndrew Loblaw Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Institute of Health Policy, Measurement and Evaluation, Toronto, Ontario, Canada Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author , Danny VespriniDanny Vesprini Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author , Liying ZhangLiying Zhang Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author , Michael W. KattanMichael W. Kattan Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , Alexandre MamedovAlexandre Mamedov Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author , Vibhuti JethavaVibhuti Jethava Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author , Perakaa SethukavalanPerakaa Sethukavalan Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author , Changhong YuChanghong Yu Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author , and Laurence KlotzLaurence Klotz Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.01.102AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We report the percentage of patients on active surveillance who had disease pathologically upgraded and factors that predict for upgrading on surveillance biopsies. Materials and Methods: Patients in our active surveillance database with at least 1 repeat prostate biopsy were included. Histological upgrading was defined as any increase in primary or secondary Gleason grade on repeat biopsy. Multivariate analysis was used to determine baseline and dynamic factors associated with Gleason upgrading. This information was used to develop a nomogram to predict for upgrading or treatment in patients electing for active surveillance. Results: Of 862 patients in our cohort 592 had 2 or more biopsies. Median followup was 6.4 years. Of the patients 20% were intermediate risk, 0.3% were high risk and all others were low risk. During active surveillance 31.3% of cases were upgraded. On multivariate analysis clinical stage T2, higher prostate specific antigen and higher percentage of cores involved with disease at the time of diagnosis predicted for upgrading. A total of 27 cases (15% of those upgraded) were Gleason 8 or higher at upgrading, and 62% of all 114 upgraded cases went on to have active treatment. The nomogram incorporated clinical stage, age, prostate specific antigen, core positivity and Gleason score. The concordance index was 0.61. Conclusions: In this large re-biopsy cohort with medium-term followup, most cases have not been pathologically upgraded to date. A model predicting for upgrading or radical treatment was developed which could be useful in counseling patients considering active surveillance for prostate cancer. References 1 : NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. J Natl Compr Canc Netw2010; 8: 162. Google Scholar 2 : Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol2007; 177: 2106. Link, Google Scholar 3 : Clinical results of long term follow-up of a large active surveillance cohort. J Clin Oncol2010; 28: 126. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGearman D, Morlacco A, Cheville J, Rangel L and Karnes R (2018) Comparison of Pathological and Oncologic Outcomes of Favorable Risk Gleason Score 3 + 4 and Low Risk Gleason Score 6 Prostate Cancer: Considerations for Active SurveillanceJournal of Urology, VOL. 199, NO. 5, (1188-1195), Online publication date: 1-May-2018.Taneja S (2018) Re: Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance CohortsJournal of Urology, VOL. 199, NO. 5, (1112-1113), Online publication date: 1-May-2018.Taneja S (2018) Re: Role of Surveillance Biopsy with no Cancer as a Prognostic Marker for Reclassification: Results from the Canary Prostate Active Surveillance StudyJournal of Urology, VOL. 200, NO. 1, (30-30), Online publication date: 1-Jul-2018.Perlis N, Sayyid R, Evans A, Van Der Kwast T, Toi A, Finelli A, Kulkarni G, Hamilton R, Zlotta A, Trachtenberg J, Ghai S and Fleshner N (2018) Limitations in Predicting Organ Confined Prostate Cancer in Patients with Gleason Pattern 4 on Biopsy: Implications for Active SurveillanceJournal of Urology, VOL. 197, NO. 1, (75-83), Online publication date: 1-Jan-2017.Helfand B (2018) Editorial CommentJournal of Urology, VOL. 197, NO. 2, (341-341), Online publication date: 1-Feb-2017.Maurice M, Zhu H, Kiechle J, Kim S and Abouassaly R (2015) Comorbid Disease Burden is Independently Associated with Higher Risk Disease at Prostatectomy in Patients Eligible for Active SurveillanceJournal of Urology, VOL. 195, NO. 4 Part 1, (919-924), Online publication date: 1-Apr-2016.Marks L (2018) Significance of Change in Gleason Grade in Patients on Active Surveillance for Prostate CancerJournal of Urology, VOL. 194, NO. 1, (8-9), Online publication date: 1-Jul-2015.Taneja S (2018) Re: Long-Term Follow-up of a Large Active Surveillance Cohort of Patients with Prostate CancerJournal of Urology, VOL. 194, NO. 5, (1286-1286), Online publication date: 1-Nov-2015. Volume 194Issue 1July 2015Page: 79-84Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordswatchful waitingnomogramsneoplasm gradingprostatic neoplasmsMetricsAuthor Information Suneil Jain Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom More articles by this author Andrew Loblaw Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Institute of Health Policy, Measurement and Evaluation, Toronto, Ontario, Canada Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author Danny Vesprini Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author Liying Zhang Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author Michael W. Kattan Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Alexandre Mamedov Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author Vibhuti Jethava Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author Perakaa Sethukavalan Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author Changhong Yu Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio More articles by this author Laurence Klotz Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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