e17092 Background: It is predicted that 1 in 8 men will be diagnosed with prostate cancer and 1 in 41 men will die of prostate cancer, making it the second leading cause of death in men. However, not all diagnosis of prostate cancer is clinically significant and active surveillance (AS) can be an option. Although AS is an option, an estimated 50% of patients will progress to treatment within 5-10 years. In this study, we aim to characterize those patients that required escalation to treatment from AS. Methods: A multicenter retrospective review was performed of patients that were had biopsy proven prostate cancer that elected to undergo AS. The cohort was subdivided into those that progressed to treatment (radiation, surgery, or hormonal therapy) and those that continued AS. Patient demographics, prostate biopsy characteristics, and biomarker usage was analyzed between the two groups. Descriptive analysis was performed and a multivariate logistic regression was performed. Results: A total of 158 patients were reviewed from 2021-2023. Among the cohort, 55 (34.2%) progressed to treatment while 106 (65.8%) remained on AS. The treated cohort were younger (63.2 vs. 68.6), had lower initial PSA (1.6 vs. 4.7), lower % free PSA (10.5 vs. 20.6), and higher number of cores positive (3.9 vs. 2.7) on biopsy. There was no difference in biomarker testing including Prolaris, Decipher, and Oncotype Dx between the treated and AS group. On adjusted analysis, age (OR 0.9, 0.81 – 0.99, P=0.035) and initial PSA (OR 0.38, 0.22 – 0.59, P&lt;0.001) were predictive covariates into treatment (Table). Conclusions: AS is an option for favorable prostate cancer. We show that there was no difference in Biomarkers, PIRADS, and PSAD between the treated and the AS group. Escalation to treatment from AS should be a shared decision making between provider and patient. Our multicenter, real-world analysis shows that younger patients and lower initial PSA were factors that were associated with escalation to treatment. [Table: see text]

Descriptive analysis of patients on active surveillance escalating to treatment for localized prostate cancer.