BACKGROUND: Active surveillance (AS) protocols for low-risk prostate cancer (PCa) generally include repeat prostate biopsies at predefined follow-up intervals. OBJECTIVE: To study the outcome of routinely obtained 1-yr repeat biopsies and factors predicting reclassification to higher risk, to contribute to risk stratification for men on AS. DESIGN, SETTING, AND PARTICIPANTS: We analysed men with low-risk PCa (clinical stage ≤ T2, prostate-specific antigen (PSA) ≤ 10 ng/ml, PSA density <0.2 ng/ml per millilitre, one or two positive biopsy cores, and Gleason score ≤ 6) who had been included in a prospective AS protocol. INTERVENTIONS: PSA was measured 3-monthly and the first volume-dependent repeat biopsy was scheduled 1 yr after diagnosis, independent of PSA doubling time (PSA-DT). Reclassification to higher risk disease on repeat biopsy was defined as Gleason score ≥ 7 or ≥ 3 positive cores. MEASUREMENTS: We analysed whether baseline patient characteristics and PSA-DT were associated with reclassification to more aggressive PCa on repeat biopsy. RESULTS AND LIMITATIONS: A first repeat biopsy was taken in 757 patients after median follow-up of 1.03 yr. The results of repeat biopsies were favourable (no or low-risk PCa) in 594 patients (78.5%) and led to reclassification of risk in 163 (21.5%). Analysis showed that reclassification to higher risk was significantly influenced by the number of initial positive cores (two vs one) (odds ratio [OR]: 1.8; p=0.002) and higher PSA density (OR: 2.1; p=0.003). The outcome was not significantly influenced by age, clinical stage, total number of biopsy cores, or PSA. Adding PSA-DT at time of repeat biopsy to the model showed PSA-DT <3 yr to be significantly associated with reclassification to higher risk (OR: 1.7; p=0.015). Data on tumour involvement per biopsy core were not available. CONCLUSIONS: Clinical features at baseline and during follow-up in our AS cohort are significantly associated with short-term reclassification to higher risk on repeat biopsy. These characteristics can potentially be used for risk stratification of men with PCa who are apparently at favourable risk.
BACKGROUND: Active surveillance (AS) protocols for low-risk prostate cancer (PCa) generally include repeat prostate biopsies at predefined follow-up intervals. OBJECTIVE: To study the outcome of routinely obtained 1-yr repeat biopsies and factors predicting reclassification to higher risk, to contribute to risk stratification for men on AS. DESIGN, SETTING, AND PARTICIPANTS: We analysed men with low-risk PCa (clinical stage ≤ T2, prostate-specific antigen (PSA) ≤ 10 ng/ml, PSA density <0.2 ng/ml per millilitre, one or two positive biopsy cores, and Gleason score ≤ 6) who had been included in a prospective AS protocol. INTERVENTIONS:PSA was measured 3-monthly and the first volume-dependent repeat biopsy was scheduled 1 yr after diagnosis, independent of PSA doubling time (PSA-DT). Reclassification to higher risk disease on repeat biopsy was defined as Gleason score ≥ 7 or ≥ 3 positive cores. MEASUREMENTS: We analysed whether baseline patient characteristics and PSA-DT were associated with reclassification to more aggressive PCa on repeat biopsy. RESULTS AND LIMITATIONS: A first repeat biopsy was taken in 757 patients after median follow-up of 1.03 yr. The results of repeat biopsies were favourable (no or low-risk PCa) in 594 patients (78.5%) and led to reclassification of risk in 163 (21.5%). Analysis showed that reclassification to higher risk was significantly influenced by the number of initial positive cores (two vs one) (odds ratio [OR]: 1.8; p=0.002) and higher PSA density (OR: 2.1; p=0.003). The outcome was not significantly influenced by age, clinical stage, total number of biopsy cores, or PSA. Adding PSA-DT at time of repeat biopsy to the model showed PSA-DT <3 yr to be significantly associated with reclassification to higher risk (OR: 1.7; p=0.015). Data on tumour involvement per biopsy core were not available. CONCLUSIONS: Clinical features at baseline and during follow-up in our AS cohort are significantly associated with short-term reclassification to higher risk on repeat biopsy. These characteristics can potentially be used for risk stratification of men with PCa who are apparently at favourable risk.
Authors: Stacy Loeb; Sophie M Bruinsma; Joseph Nicholson; Alberto Briganti; Tom Pickles; Yoshiyuki Kakehi; Sigrid V Carlsson; Monique J Roobol Journal: Eur Urol Date: 2014-10-31 Impact factor: 20.096
Authors: Javier Romero-Otero; Borja García-Gómez; José M Duarte-Ojeda; Alfredo Rodríguez-Antolín; Antoni Vilaseca; Sigrid V Carlsson; Karim A Touijer Journal: Int J Urol Date: 2015-11-30 Impact factor: 3.369
Authors: Xiaosong Meng; Andrew B Rosenkrantz; Neil Mendhiratta; Michael Fenstermaker; Richard Huang; James S Wysock; Marc A Bjurlin; Susan Marshall; Fang-Ming Deng; Ming Zhou; Jonathan Melamed; William C Huang; Herbert Lepor; Samir S Taneja Journal: Eur Urol Date: 2015-06-22 Impact factor: 20.096
Authors: Vitor da Silva; Ilias Cagiannos; Luke T Lavallée; Ranjeeta Mallick; Kelsey Witiuk; Sonya Cnossen; James A Eastham; Dean A Fergusson; Chris Morash; Rodney H Breau Journal: Can Urol Assoc J Date: 2017-08 Impact factor: 1.862