MP9-02 OLDER AGE PREDICTS GLEASON SCORE UPGRADING DURING LONG-TERM MONITORING ON ACTIVE SURVEILLANCE (2015)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2015MP9-02 OLDER AGE PREDICTS GLEASON SCORE UPGRADING DURING LONG-TERM MONITORING ON ACTIVE SURVEILLANCE Jeffrey Tosoian, Amar Srivastava, Max Kates, Patricia Landis, Jonathan Epstein, Mufaddal Mamawala, H. Ballentine Carter, and Bruce Trock Jeffrey TosoianJeffrey Tosoian More articles by this author , Amar SrivastavaAmar Srivastava More articles by this author , Max KatesMax Kates More articles by this author , Patricia LandisPatricia Landis More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , Mufaddal MamawalaMufaddal Mamawala More articles by this author , H. Ballentine CarterH. Ballentine Carter More articles by this author , and Bruce TrockBruce Trock More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.362AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) with curative intent may reduce overtreatment in carefully selected men and has been considered best-suited for older men. We aimed to evaluate the effect of advancing age on the risk of grade reclassification in men followed on surveillance for more than five years. METHODS Men with favorable-risk (low risk and very low risk) disease were followed using semiannual PSA and DRE and annual 12–14 core surveillance biopsy. To minimize the impact of misclassification due to initial undersampling, we identified men on AS for at least five years in which all repeat biopsies confirmed favorable-risk disease. Cox proportional hazards models were used to assess the impact of pertinent clinical variables on the risk of late grade reclassification (LGR, upgrading from Gleason score 6 to >7 after five or more years on AS). Factors impacting the relationship of age and outcome and those determined a priori to be clinically significant were included. Death and volume reclassification were treated as competing risks. RESULTS Of 1,298 men enrolled in AS, 343 (26.4%) have been followed for at least five years (median 7.6, range 5.0-19.7). Of these, 38 men (11.1%) were subsequently reclassified to Gleason score 7 or above. Median age at enrollment was similar in men who did and did not demonstrate LGR (64.6 vs. 65.4, p=0.91), while median follow-up time was longer in men without LGR (7.7 vs. 7.0 years, p=0.004). On multivariate analysis including age, year of enrollment, very low risk disease, and interval between biopsies, LGR was significantly associated with age >70 years and more frequent biopsies during follow-up (Table 1). Considering age as a continuous variable, risk of LGR was 9% greater with each additional year of age (HR 1.09, 95%CI 1.01-1.18, p=0.026). CONCLUSIONS Older age represents a significant risk factor for reclassification to higher-grade cancer in men followed on AS for more than five years. These data suggest that older men may require more vigilant follow-up, rather than less. Table 1. Multivariate Hazard Ratio for Late Grade Reclassification HR (95% CI) P-value Age (years) Less than 60: Reference -- 60-69: 1.48 (0.60-3.63) 0.389 ≥ 70: 4.55 (1.56-13.32) 0.006* Year of enrollment 0.93 (0.84-1.03) 0.176 Very low risk disease (vs. low risk) 0.75 (0.30-1.86) 0.534 Months between biopsies 0.89 (0.80-0.99) 0.030* © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e102 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Tosoian More articles by this author Amar Srivastava More articles by this author Max Kates More articles by this author Patricia Landis More articles by this author Jonathan Epstein More articles by this author Mufaddal Mamawala More articles by this author H. Ballentine Carter More articles by this author Bruce Trock More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...