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• W2799840789 abstract "No AccessJournal of UrologyAdult Urology1 Nov 2018Subtyping the Risk of Intermediate Risk Prostate Cancer for Active Surveillance Based on Adverse Pathology at Radical Prostatectomy Hiten D. Patel, Mohit Gupta, Jeffrey J. Tosoian, H. Ballentine Carter, Alan W. Partin, and Jonathan I. Epstein Hiten D. PatelHiten D. Patel More articles by this author , Mohit GuptaMohit Gupta More articles by this author , Jeffrey J. TosoianJeffrey J. Tosoian More articles by this author , H. Ballentine CarterH. Ballentine Carter More articles by this author , Alan W. PartinAlan W. Partin More articles by this author , and Jonathan I. EpsteinJonathan I. Epstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.04.058AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Intermediate risk prostate cancer is a heterogenous classification with favorable proposed criteria based on men treated with radiation therapy. However, there is uncertain application to active surveillance. We quantified the rate of adverse surgical pathology and implications for survival in patients at favorable intermediate risk compared to those with low risk prostate cancer. Materials and Methods: We performed a comparative cohort study of men with prostate cancer from 2009 to 2013 in the National Cancer Database who underwent radical prostatectomy. The study primary end point was adverse pathology, defined as Grade Group 3 or greater/pT3b/pN1. Various favorable intermediate risk definitions were evaluated, including the Memorial Sloan Kettering Cancer Center definition of Grade Group 2 or less with only 1 intermediate risk factor (Grade Group 2/cT2b/prostate specific antigen 10 to 20 ng/ml), which we defined as type 1 intermediate risk. The remaining patients at intermediate risk were classified as type 2 intermediate risk. Log binomial, logistic and Cox proportional hazards regression models were applied. Results: Adverse pathological findings were noted in 3,519 of the 51,688 patients (6.8%) at low risk and 8,888 of the 42,720 Grade Group 2 patients (20.8%) at intermediate risk (RR 3.06, 95% CI 2.95–3.17, p <0.001). Stratification by prostate specific antigen and volume minimally impacted the absolute rate. Results were similar for the Memorial Sloan Kettering Cancer Center definition (type 1 intermediate risk). Type 2 intermediate risk led to a greater risk of adverse pathology (RR 8.52, 8.23–8.82, p <0.001) and Grade Group 1 intermediate risk led to lower risk (RR 2.00, 1.86–2.16, p <0.001). Patients at favorable intermediate risk had worse overall survival than patients at low risk in adjusted models due to adverse pathology. Conclusions: Adverse pathology at radical prostatectomy was observed at a threefold higher rate in patients classified at favorable intermediate risk compared to low risk, leading to worse overall survival. Men at intermediate risk may be better classified as types 1 and 2 since none showed pathological outcomes similar to those of men at low risk. References 1 : A new risk classification system for therapeutic decision making with intermediate-risk prostate cancer patients undergoing dose-escalated external-beam radiation therapy. Eur Urol2013; 64: 895. Google Scholar 2 : Risk group and death from prostate cancer: implications for active surveillance in men with favorable intermediate-risk prostate cancer. JAMA Oncol2015; 1: 334. Google Scholar 3 : Prostate cancer, version 1.2016. J Natl Compr Canc Netw2016; 14: 19. Google Scholar 4 : Active surveillance in intermediate risk prostate cancer: survival outcomes in the Sunnybrook experience. J Urol2016; 196: 1651. Link, Google Scholar 5 : Adverse pathologic findings for men electing immediate radical prostatectomy: defining a favorable intermediate-risk group. JAMA Oncol2018; 4: 89. Google Scholar 6 : Variability in outcomes for patients with intermediate-risk prostate cancer (Gleason score 7, International Society of Urological Pathology Gleason Group 2-3) and implications for risk stratification: a systematic review. Eur Urol Focus2017; 3: 487. Google Scholar 7 : Practice patterns and individual variability of surgeons performing radical prostatectomy at a high volume academic center. J Urol2015; 193: 812. Link, Google Scholar 8 : Comparison of cases captured in the national cancer data base with those in population-based central cancer registries. Ann Surg Oncol2013; 20: 1759. Google Scholar 9 : Mandatory second opinion in surgical pathology referral material: clinical consequences of major disagreements. Am J Surg Pathol2008; 32: 732. Google Scholar 10 : Tumor volume on biopsy in low risk prostate cancer managed with active surveillance. J Urol2018; 199: 954. Link, Google Scholar 11 : Active surveillance for intermediate risk prostate cancer. Curr Urol Rep2017; 18: 80. Google Scholar 12 : Improving prostate cancer screening and diagnosis: health policy and biomarkers beyond PSA. JAMA Oncol2016; 2: 867. Google Scholar 13 : Dynamic contrast enhanced magnetic resonance imaging improves classification of prostate lesions: a study of pathological outcomes on targeted prostate biopsy. J Urol2017; 198: 1301. Link, Google Scholar 14 : Use of the Prostate Health Index for detection of prostate cancer: results from a large academic practice. Prostate Cancer Prostatic Dis2017; 20: 228. Google Scholar 15 : Gleason score 3 + 4=7 prostate cancer with minimal quantity of Gleason pattern 4 on needle biopsy is associated with low-risk tumor in radical prostatectomy specimen. Am J Surg Pathol2014; 38: 1096. Google Scholar 16 : Predicting 15-year prostate cancer specific mortality after radical prostatectomy. J Urol2011; 185: 869. Link, Google Scholar 17 : A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol2016; 69: 428. Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByMortezavi A, Krauter J, Gu A, Sonderer J, Bruhin J, Reeve K, Held L, Donati O, Rupp N, Moch H, Sulser T and Eberli D (2019) Extensive Histological Sampling following Focal Therapy of Clinically Significant Prostate Cancer with High Intensity Focused UltrasoundJournal of Urology, VOL. 202, NO. 4, (717-724), Online publication date: 1-Oct-2019. Volume 200Issue 5November 2018Page: 1068-1074Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsclassificationpathologymortalityrisk factorsprostatic neoplasmssurgicalMetricsAuthor Information Hiten D. Patel More articles by this author Mohit Gupta More articles by this author Jeffrey J. Tosoian More articles by this author H. Ballentine Carter More articles by this author Alan W. Partin More articles by this author Jonathan I. Epstein More articles by this author Expand All Advertisement Loading ..." @default.
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• W2799840789 title "Subtyping the Risk of Intermediate Risk Prostate Cancer for Active Surveillance Based on Adverse Pathology at Radical Prostatectomy" @default.
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