Jonathan Olivier1,2,3, Veeru Kasivisvanathan4,5, Elodie Drumez6, Jean-Christophe Fantoni7, Xavier Leroy8,9, Philippe Puech10,8,11, Arnauld Villers10,8,7. 1. INSERM, U1189, ONCO-THAI, 59037, Lille, France. jonathan.olivier@chru-lille.fr. 2. Univ Lille, 59000, Lille, France. jonathan.olivier@chru-lille.fr. 3. Department of Urology, CHRU Lille, Lille University, Lille, France. jonathan.olivier@chru-lille.fr. 4. Division of Surgery and Interventional Science, University College London, London, UK. 5. Department of Urology, University College London Hospital, London, UK. 6. Santé publique: Épidémiologie et Qualité des Soins, Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694, 59000, Lille, France. 7. Department of Urology, CHRU Lille, Lille University, Lille, France. 8. Univ Lille, 59000, Lille, France. 9. Department of Pathology, CHRU Lille, Lille University, Lille, France. 10. INSERM, U1189, ONCO-THAI, 59037, Lille, France. 11. Department of Radiology, CHRU Lille, Lille University, Lille, France.
Abstract
PURPOSE: In patients considered for active surveillance (AS), the use of MRI and targeted biopsies (TB) at entry challenges the approach of routine "per protocol" repeat systematic biopsies (SB) at 1 year. This pilot study aimed to assess whether an approach of performing repeat biopsies only if PSA kinetics are abnormal would be safe and sufficient to detect progression. METHODS: Prospective single-centre study of 149 patients on AS with low-risk PCa, a negative MRI at entry, followed for a minimum of 12 months between 01/2007 and 12/2015. Group 1 (n = 78) patients had per-protocol 12-month repeat SB; group 2 (n = 71) patients did not. Surveillance tests for tumour progression were for both groups: for cause SB and MRI-TB biopsies if PSA velocity (PSA-V) > 0.75 ng/ml/year, or PSA doubling time (PSADT) < 3 years. The main objectives are to compare the 2-year rates of tumour progression and AS discontinuation between groups. The secondary objectives are to estimate the diagnostic power of PSA-V and PSA-DT, to predict the risk of tumour progression. RESULTS: Overall, 21 out of 149 patients (14.1%) showed tumour progression, 17.1% for group 1 and 12.3% for group 2, and 31 (21.2%) discontinued AS at 2 years. There was no difference between the 2 groups (p = 0.56). The area under the PSA-V and PSADT curves to predict tumour progression was 0.92 and 0.83, respectively. CONCLUSIONS: We did not find any significant difference for progression and AS discontinuation rate between the 2 groups. The PSA kinetic seems accurate as a marker of tumour progression. These results support the conduct of a multi-centre prospective trial to confirm these findings.
PURPOSE: In patients considered for active surveillance (AS), the use of MRI and targeted biopsies (TB) at entry challenges the approach of routine "per protocol" repeat systematic biopsies (SB) at 1 year. This pilot study aimed to assess whether an approach of performing repeat biopsies only if PSA kinetics are abnormal would be safe and sufficient to detect progression. METHODS: Prospective single-centre study of 149 patients on AS with low-risk PCa, a negative MRI at entry, followed for a minimum of 12 months between 01/2007 and 12/2015. Group 1 (n = 78) patients had per-protocol 12-month repeat SB; group 2 (n = 71) patients did not. Surveillance tests for tumour progression were for both groups: for cause SB and MRI-TB biopsies if PSA velocity (PSA-V) > 0.75 ng/ml/year, or PSA doubling time (PSADT) < 3 years. The main objectives are to compare the 2-year rates of tumour progression and AS discontinuation between groups. The secondary objectives are to estimate the diagnostic power of PSA-V and PSA-DT, to predict the risk of tumour progression. RESULTS: Overall, 21 out of 149 patients (14.1%) showed tumour progression, 17.1% for group 1 and 12.3% for group 2, and 31 (21.2%) discontinued AS at 2 years. There was no difference between the 2 groups (p = 0.56). The area under the PSA-V and PSADT curves to predict tumour progression was 0.92 and 0.83, respectively. CONCLUSIONS: We did not find any significant difference for progression and AS discontinuation rate between the 2 groups. The PSA kinetic seems accurate as a marker of tumour progression. These results support the conduct of a multi-centre prospective trial to confirm these findings.
Entities:
Keywords:
Active surveillance; MRI; PSA kinetics; Prostate cancer; Repeat biopsy
Authors: Roderick C N van den Bergh; Stijn Roemeling; Monique J Roobol; Gunnar Aus; Jonas Hugosson; Antti S Rannikko; Teuvo L Tammela; Chris H Bangma; Fritz H Schröder Journal: Eur Urol Date: 2008-09-17 Impact factor: 20.096
Authors: Ali Khatami; Khatami Ali; Gunnar Aus; Aus Gunnar; Jan-Erik Damber; Damber Jan-Erik; Hans Lilja; Lilja Hans; Pär Lodding; Lodding Pär; Jonas Hugosson; Hugosson Jonas Journal: Int J Cancer Date: 2007-01-01 Impact factor: 7.396
Authors: Viacheslav Iremashvili; Murugesan Manoharan; Soum D Lokeshwar; Daniel L Rosenberg; David Pan; Mark S Soloway Journal: BJU Int Date: 2012-06-15 Impact factor: 5.588
Authors: Meelan Bul; Xiaoye Zhu; Riccardo Valdagni; Tom Pickles; Yoshiyuki Kakehi; Antti Rannikko; Anders Bjartell; Deric K van der Schoot; Erik B Cornel; Giario N Conti; Egbert R Boevé; Frédéric Staerman; Jenneke J Vis-Maters; Henk Vergunst; Joris J Jaspars; Petra Strölin; Erik van Muilekom; Fritz H Schröder; Chris H Bangma; Monique J Roobol Journal: Eur Urol Date: 2012-11-12 Impact factor: 20.096
Authors: Mark S Soloway; Cynthia T Soloway; Steve Williams; Rajinikanth Ayyathurai; Bruce Kava; Murugesan Manoharan Journal: BJU Int Date: 2007-09-10 Impact factor: 5.588
Authors: Hiten D Patel; Zhaoyong Feng; Patricia Landis; Bruce J Trock; Jonathan I Epstein; H Ballentine Carter Journal: J Urol Date: 2013-09-20 Impact factor: 7.450
Authors: Ramachandran Venkitaraman; Andrew Norman; Ruth Woode-Amissah; Cyril Fisher; David Dearnaley; Alan Horwich; Robert Huddart; Vincent Khoo; Alan Thompson; Chris Parker Journal: J Urol Date: 2007-07-16 Impact factor: 7.450
Authors: Jonathan Olivier; Weiyu Li; Daan Nieboer; Jozien Helleman; Monique Roobol; Vincent Gnanapragasam; Mark Frydenberg; Mikio Sugimoto; Peter Carroll; Todd M Morgan; Riccardo Valdagni; Jose Rubio-Briones; Grégoire Robert; Phillip Stricker; Andrew Hayen; Ivo Schoots; Masoom Haider; Caroline M Moore; Brian Denton; Arnauld Villers Journal: Eur Urol Open Sci Date: 2022-01-03