EURURO Vol. 72 No. 3

329 476

Brief Correspondence
Quantified Clinical Risk Change as an End Point During Prostate
Cancer Active Surveillance
Michael S. Leapman Niloufar Ameli Matthew R. Cooperberg Carissa Chu
Ahmed Hussein [2_TD$DIFF] Katsuto Shinohara Peter R. Carroll
a Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; bEpidemiology and Biostatistics,
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; [3_TD$DIFF]cDepartment of Urology, Cairo University, Egypt
For men with favorable-risk prostate cancer (PCa) managed
with active surveillance (AS), firm end points have not been
prospectively evaluated. As a result, definitive intervention is
often undertaken in the setting of changes in biopsy grade,
prostate-specific antigen (PSA), tumor volume estimates, or
personal preference . While periodic monitoring of such
clinical characteristics offers numerous opportunities for risk
appraisal, it is unclear whether changes in individual
parameters offer equal value in informing the necessity of
treatment. Furthermore, it is unknown if changes inmultiple
relevant characteristics may serve as an improved end point
for men managed with surveillance. Consequently, we
ava ilable at
journal homepage:
Article info
Article history:
Accepted April 20, 2016
Associate Editor:
Giacomo Novara
Keywords:
Prostate cancer
Active surveillance
End point
CAPRA
Abstract
For men with low-stage prostate cancer (PCa) managed with active surveillance (AS),
clinical thresholds for intervention have not been definitively established. We aimed to
evaluate whether the magnitude of quantitative risk change may serve as a refined end
point. We identified 735 men managed with AS at our institution who received a
minimum of two biopsies and who were followed for a median of 52 mo. We described
the relative changes in the Cancer of the Prostate Risk Assessment (CAPRA) score from
diagnosis to last follow-up and evaluated the proportion of patients experiencing
changes in constituent clinical variables. Among patients treated with radical prosta-
tectomy (RP), the association between change in CAPRA score and the occurrence of
adverse pathology (pT3a or higher and/or primary Gleason pattern 4) was assessed
using logistic regression models. Among patients ultimately treated with RP (n = 196),
unit increases in CAPRA score from diagnosis were associated with the occurrence of
adverse pathology (odds ratio: 1.60; 95% confidence interval, 1.25–2.04; p < [4_TD$DIFF]0.01). On
this basis, disease reclassification should be regarded from the vantage of multiple
parameters.
Patient summary: In this study of men with favorable-risk prostate cancer on active
surveillance, we evaluated the change in risk status from initial diagnosis to last biopsy
using a readily tabulated clinical instrument. Unit change in the Cancer of the Prostate
Risk Assessment (CAPRA) score was associated with increasing risk of adverse patho-
logic findings at delayed prostatectomy. This framework may be useful to stratify men
based on the degree of clinical change from baseline over time.
# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author. 550 16th Street, UCSF Box 1695, San Francisco, CA 94143-1695, USA.
Tel. +1 415 353 9779; Fax: +1 415 353 9932.
E-mail address: (M.S. Leapman).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.