Evaluating 4Kscore's Role in Predicting Progression on Active Surveillance for Prostate Cancer Independently of Clinical Information and PIRADS Score

Overview

Journal Prostate Cancer Prostatic Dis

Specialties Oncology
Urology

Date 2024 Sep 27

PMID 39333697

Authors

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

Affiliations

Soon will be listed here.

Abstract

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.

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