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MP66-02 NUMBER OF BIOPSY CORES CONTAINING GRADE GROUP 2 IS PROGNOSTIC FOR ADVERSE PATHOLOGIC FEATURES AND PROSTATE CANCER RECURRENCE

INTRODUCTION AND OBJECTIVES: Among men with intermediate risk prostate cancer, those with low biopsy volume Grade Group (GG) 2, formerly Gleason 3+4, may be considered for initial conservative management, particularly in the context of significant co-morbidities. In order to better understand oncologically safe thresholds in this population, we analyzed pathologic and oncologic outcomes in patients with highest GG 2 prostate cancer who underwent radical prostatectomy (RP), focusing on the number of biopsy cores specifically containing GG 2. METHODS: A prospectively maintained institutional RP database was queried to identify intermediate risk patients with GG 2 on biopsy. Subjects were categorized according to number of biopsy cores containing GG 2 disease (1, 2-3, >3 cores), PSA (0-5, 5-10, 10-20 ng/ml), and clinical stage (cT1, cT2). Biochemical recurrence (BCR) was defined as a confirmed post-RP PSA >0.2 ng/ml. Factors associated with BCR after RP were analyzed using univariate and multivariable Cox models. RESULTS: We identified 938 men who underwent RP since 2005 with sufficient follow-up data. PSA >10 ng/ml (13% vs 4-8% in lower PSA groups, p=0.01) and stage cT2 (9% vs 5% for cT1c, p =0.02) were associated with higher rates of seminal vesicle invasion. The presence of GG 2 cancer in >3 cores was associated with higher rates of both seminal vesicle invasion (14% vs 2-7% in lower volume groups, p<0.001) and pathologic nodal metastases (6% vs 0.7-1% in lower volume groups, p<0.001). In a multivariable Cox model adjusted for age, PSA, stage, and treatment year, the number of biopsy cores containing GG 2 cancer was associated with a more than two-fold increase in hazard of BCR (>3 cores vs. 1 core, Hazard Ratio (HR)=2.3, 95% CI 1.4-3.9, p=0.002). PSA and clinical stage were also independently associated with BCR in this cohort. CONCLUSIONS: Among men with intermediate-risk GG 2 prostate cancer, the number of biopsy cores containing GG 2 disease appears to be a clinically meaningful prognostic marker of pathologic and oncologic outcomes. These data suggest that volume of GG 2 on biopsy may be a marker of unfavorable risk disease. Source of Funding: None