Mp55-05 baseline 4k score predicts progression on active surveillance in prostate cancer independently of clinical information and pirads score

You have accessJournal of UrologyCME1 Apr 2023MP55-05 BASELINE 4K SCORE PREDICTS PROGRESSION ON ACTIVE SURVEILLANCE IN PROSTATE CANCER INDEPENDENTLY OF CLINICAL INFORMATION AND PIRADS SCORE Helen Hougen, Isildinha M. Reis, Nachiketh S. Prakash, Ruben Blachman-Braun, Jessica Delgado, Chad R. Ritch, Bruno Nahar, Mark L. Gonzalgo, Dipen J. Parekh, Radka Stoyanova, Sandra M. Gaston, Oleksandr Kryvenko, Brandon Mahal, Matthew Abromowitz, Alan Dal Pra, Alan Pollack, and Sanoj Punnen Helen HougenHelen Hougen More articles by this author , Isildinha M. ReisIsildinha M. Reis More articles by this author , Nachiketh S. PrakashNachiketh S. Prakash More articles by this author , Ruben Blachman-BraunRuben Blachman-Braun More articles by this author , Jessica DelgadoJessica Delgado More articles by this author , Chad R. RitchChad R. Ritch More articles by this author , Bruno NaharBruno Nahar More articles by this author , Mark L. GonzalgoMark L. Gonzalgo More articles by this author , Dipen J. ParekhDipen J. Parekh More articles by this author , Radka StoyanovaRadka Stoyanova More articles by this author , Sandra M. GastonSandra M. Gaston More articles by this author , Oleksandr KryvenkoOleksandr Kryvenko More articles by this author , Brandon MahalBrandon Mahal More articles by this author , Matthew AbromowitzMatthew Abromowitz More articles by this author , Alan Dal PraAlan Dal Pra More articles by this author , Alan PollackAlan Pollack More articles by this author , and Sanoj PunnenSanoj Punnen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is the preferred management in low and select intermediate risk prostate cancer patients. Currently, the 4Kscore identifies men with grade group 2+ disease in men with clinical suspicion of prostate cancer but little is known about its utility in men undergoing AS. In this study, we assessed the 4Kscore’s ability to predict tumor progression on men enrolled in a prospective active surveillance protocol. METHODS: We enrolled patients with biopsy-confirmed very low to intermediate risk prostate cancer who elected for AS and obtained prostate MRI, 4Kscore, and targeted +/- systematic biopsy within 1 year of diagnosis and then yearly for 3 years. The 4Kscore was categorized as low (=<20%) and high (=>20%) risk. We estimated cumulative incidence rates of progression over time by the Kaplan-Meier method and used multivariable Cox analyses to assess the association between the 4Kscore and progression while adjusting for NCCN risk at diagnosis, age, PSA density and baseline PIRADS score. RESULTS: The 4Kscore was collected in 166 men at the time of confirmatory biopsy. Over half the patients had a PIRADS 4 or 5 lesions and 4K score of over 20% at baseline. A total of 79 (47.6%) patients progressed during the study period, with 26.5%, 13.3%, 5.4%, and 2.4% progressing at the baseline, 12-month, 24- month, and 36-month visit, respectively. Patients who progressed had higher baseline 4Kscore compared with patients who did not progress (31% IQR 15-59 vs. 14% IQR 8-35, p<0.001; Figure 1a). Patients with a 4Kscore above 20% had higher cumulative incidence of progression by 36 months compared with patients with 4Kscores less than 20% (72.5% [95% CI 60.9-83.1%] vs. 41.0% [95% CI: 28.6-56.3%], p=0.0001, Figure 1b). In a multivariable Cox analysis, 4Kscore above 20% was an independent predictor of progression (HR 1.73, 95% CI: 1.03, 2.88, p=0.037), after adjusting for age, NCCN risk, PSA density and PIRADS score. CONCLUSIONS: Patients with a 4Kscore above 20% have a higher likelihood of progression despite their NCCN risk and MRI findings. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e764 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Helen Hougen More articles by this author Isildinha M. Reis More articles by this author Nachiketh S. Prakash More articles by this author Ruben Blachman-Braun More articles by this author Jessica Delgado More articles by this author Chad R. Ritch More articles by this author Bruno Nahar More articles by this author Mark L. Gonzalgo More articles by this author Dipen J. Parekh More articles by this author Radka Stoyanova More articles by this author Sandra M. Gaston More articles by this author Oleksandr Kryvenko More articles by this author Brandon Mahal More articles by this author Matthew Abromowitz More articles by this author Alan Dal Pra More articles by this author Alan Pollack More articles by this author Sanoj Punnen More articles by this author Expand All Advertisement PDF downloadLoading ...