High-risk score linked to adverse pathology
Patients in grade group 1 or 2 who had a high-risk score had a much greater chance of having adverse pathology than those with a low-risk score. Gleason grade 4 or 5 cancer was present in 20.3% of the high-risk group compared with 10.2% in the low-risk group (p=.14). Patients in the high-risk group also had triple the rate of T3 or T4 cancer versus those in the low-risk group (36.2% vs. 12.2%; p=.004).
“Possibly more importantly, patients with a low-risk score had <15% chance of having adverse pathology, suggesting they may be good candidates to remain safely on AS,” said Dr. Hurley.
In examining pathology in the group appropriate for AS by MUSIC criteria, the high-risk group via the CCP test had a much higher rate of Gleason 4 or 5 cancer than the low-risk group (21.7% vs. 3.2%; p=.73) as well as double the rate of stage T3 or T4 disease (17.4% vs. 9.7%; p=.44).
Urologists seemed to be influenced by the CCP test results in choosing patients for AS, Dr. Hurley said. Among patients in grade groups 1 and 2, half of the patients with a low CCP score were chosen for AS, whereas only 14% with a high CCP score were chosen for AS.
“If they were in grade group 1 (Gleason 6 only), there didn’t seem to be any difference, likely because they were going to go on AS anyways,” he said.
“For the patients who are candidates for AS, whether through the MUSIC appropriateness criteria or grade group 1, they were the ones with low-risk scores and low rates of adverse pathology, suggesting that likely they’re safe to remain on AS,” Dr. Hurley concluded.
One of Dr. Hurley’s co-authors is a consultant/adviser for Myriad Genetics, Inc. The study received funding from Blue Cross and Blue Shield of Michigan and a grant from the National Cancer Institute.
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