Using disease prognosis to guide inclusion criteria, stratify follow-up and standardise end-points in active surveillance for prostate cancer.
BAUS ePoster online library. Gnanapragasam V. Jun 24, 2019; 259553; P5-9
Mr. Vincent Gnanapragasam
Mr. Vincent Gnanapragasam
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
Introduction
There is no consensus on the optimal active surveillance (AS) strategy or when surveillance should stop. We used disease prognosis to investigate an evidence base approach to AS.

METHODS

We have reported the Cambridge Prognostics Groups (CPG), a 5-tiered model that uses PSA, Grade Group and stage at diagnosis to predict prostate cancer mortality (PCM). We applied the CPG model to a UK and Swedish prostate cancer cohort to compare PCM in treated and untreated men with CPG2 and CPG3 (comparable to AUA favourable-intermediate and unfavourable-intermediate risk) versus CPG1 (low-risk) disease. We next applied the CPG model to a contemporary AS cohort.

RESULTS

The UK cohort comprised 3659 men (CPG1-1299, CPG2-1413, CPG3-947). 10-year cumulative PCM was 2.3% in CPG1, 1.5% and 3.5% in treated/un-treated CPG2 and 1.9% and 8.6% in treated/un-treated CPG3. The Swedish cohort comprised 27,942 men (CPG1-15,477, CPG2-8495, CPG3-3970). 10-year PCM rate was 1.0% in CPG1, 2.2% and 2.7% in treated vs untreated CPG2 and 6.1% and 12.5% in treated vs untreated CPG3. We therefore tested progression to CPG3 as an AS endpoint. In a contemporary MRI-imaging characterised AS cohort (n=133) only 6% progressed to CPG3 over 3.5y median follow-up. PSA density ≥0.15 and CPG2 at diagnosis were predictors of progression with 21% of men with both attributes, 8% with either one and 1% with neither progressing.

CONCLUSION

A definite poorer prognosis without treatment (CPG3) is an unambiguous reason for AS discontinuation. Using this, we have identified diagnostic risk-factors of progression and propose a stratified surveillance strategy.
    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings