ESTRO 2025 - Abstract Book

S2019

Clinical - Urology

ESTRO 2025

Results:

The study initially included 1409 men, of whom 25 were excluded due to Gleason categories 4+3 or 4+4, leaving 1384 patients analyzed. With a median follow-up of 11.2 years (range 1.2 – 26.4 years), the RPA identified MRI use, Gleason grade (GG), PSA levels, and APP4 categories as critical predictors of FFM. Patients with GG1 and PSA <10 exhibited excellent outcomes, with 15-year FFM rates exceeding 95%. For GG2 patients, those with APP4 <1 had significantly better outcomes compared to those with APP4 ≥1, who demonstrated increased risk of metastasis (HR 2.9). Notably, APP4 ≥1 categories were combined due to a low number of patients with APP4 >5 in the MRI subgroup. Conclusion: Patients with GG1 and PSA <10 or GG2 with APP4 <1 have low risk of metastases and prostate cancer-specific mortality, making them ideal candidates for active surveillance. Conversely, GG2 and APP4 ≥1 patients may require closer monitoring or definitive treatment. These findings enhance risk stratification in IRPC and support personalized management strategies for safe AS application. References: 1. Diven MA, Tshering L, et al. Trends in Active Surveillance for Men With Intermediate-Risk Prostate Cancer. JAMA Netw Open . 2024;7(8):e2429760. Published 2024 Aug 1. 2. Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med . 2023;388(17):1547-1558. 3. Klotz L, Pond G, Loblaw A, et al. Randomized Study of Systematic Biopsy Versus Magnetic Resonance Imaging and Targeted and Systematic Biopsy in Men on Active Surveillance (ASIST): 2-year Postbiopsy Follow-up. Eur Urol . 2020;77(3):311-317. 4. Klotz L, Loblaw A, et al. Active Surveillance Magnetic Resonance Imaging Study (ASIST): Results of a Randomized Multicenter Prospective Trial. Eur Urol . 2019;75(2):300-309. Keywords: Active Surveillance, Prostate, MRI