TY - JOUR AU - Tan, Guan Hee 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 PY - 2019/06/17 Y2 - 2024/03/29 TI - A novel predictor of clinical progression in patients on active surveillance for prostate cancer JF - Canadian Urological Association Journal JA - CUAJ VL - 13 IS - 8 SE - Original Research DO - 10.5489/cuaj.6122 UR - https://cuaj.ca/index.php/journal/article/view/6122 SP - AB - <p><strong>Introduction:</strong> 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).</p><p><strong>Methods:</strong> This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and &lt;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.</p><p><strong>Results:</strong> 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 (&gt;0.05) was independently associated with time to CP (hazard ratio [HR] 4.70; 95% confidence interval [CI] 2.62‒8.42; p&lt;0.001) and GP (HR 3.85; 95% CI 1.91‒7.73; p&lt;0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression.</p><p><strong>Conclusions:</strong> 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.</p> ER -