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Evaluating 4Kscore’s role in predicting progression on active surveillance for prostate cancer independently of clinical information and PIRADS score

  • 期刊论文

  • 发表日期：

    2024年9月27日

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  • Helen Y. Hougen,
  • Isildinha M. Reis,
  • Sunwoo Han,
  • Nachiketh Soodana Prakash,
  • Jamie Thomas,
  • Radka Stoyanova,
  • R. Patricia Castillo,
  • Oleksandr N. Kryvenko,
  • Chad R. Ritch,
  • Bruno Nahar,
  • Mark L. Gonzalgo,
  • Sandra M. Gaston,
  • Matthew C. Abramowitz,
  • Alan Dal Pra,
  • Brandon A. Mahal,
  • Alan Pollack,
  • Dipen J. Parekh,
  • Sanoj Punnen

摘要

Background

4Kscore is used to aid the decision for prostate biopsy, however its role in active surveillance (AS) has not been investigated in a magnetic resonance imaging (MRI)-based protocol. Our objective was to assess the association between 4Kscore and progression in men undergoing AS on a prospective MRI-based protocol.

Methods

This was a single-institution, single-arm, non-therapeutic, interventional trial of 166 men with biopsy-confirmed prostate cancer enrolled between 2014–2020. Patients were placed on a trial-mandated AS protocol including yearly multiparametric (mp)MRI, prostate biopsy, and 4Kscore followed for 48 months after diagnosis. We analyzed protocol-defined and grade progression at confirmatory and subsequent surveillance biopsies.

Results

Out of 166 patients, 83 (50%) men progressed per protocol and of them 41 (24.7% of whole cohort) progressed by grade. At confirmatory biopsy, men with a baseline 4Kscore ≥ 20% had a higher risk of grade progression compared to those with 4Kscore < 20% (OR = 4.04, 95% CI: 1.05–15.59, p = 0.043) after adjusting for National Comprehensive Cancer Network (NCCN) risk and baseline PIRADS score. At surveillance biopsies, most recent 4Kscore ≥ 20% significantly predicted per protocol (OR = 2.61, 95% CI: 1.03–6.63, p = 0.044) and grade progression (OR = 5.13, 95% CI: 1.63–16.11, p = 0.005).

Conclusions

For patients on AS, baseline 4Kscore predicted grade progression at confirmatory biopsy, and most recent 4Kscore predicted per-protocol and grade progression at surveillance biopsy.