Emmeli Palmstedt1, Marianne Månsson2, Maria Frånlund2, Johan Stranne2, Carl-Gustaf Pihl3, Jonas Hugosson2, Rebecka Arnsrud Godtman2. 1. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sweden. Electronic address: emmeli_p@hotmail.com. 2. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sweden. 3. Department of Pathology, Institute of Biomedicine, Sahlgrenska Academy at University of Göteborg, Sweden.
Abstract
BACKGROUND: The optimal follow-up regimen for men after a benign prostate biopsy remains unknown. OBJECTIVE: To investigate long-term outcomes for men after an initial benign prostate biopsy. DESIGN, SETTING, AND PARTICIPANTS: All men with a benign biopsy in the first screening round of the Göteborg prostate cancer (PC) screening trial were included. The follow-up period was January 1, 1995-May 15, 2017. INTERVENTION: Prostate-specific antigen (PSA) tests were performed every second year (upper median age limit 69yr). Men with PSA ≥3ng/ml underwent prostate biopsy (sextant biopsy up to 2009). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The 20-yr cumulative PC incidence and PC mortality were calculated using the 1 minus Kaplan-Meier method. RESULTS AND LIMITATIONS: Of 452 men with a benign biopsy and followed for a median of 21.1yr, 169 were diagnosed with PC and five died from PC. The 20-yr cumulative PC incidence and PC mortality were 40.0% and 1.4%, respectively. The corresponding figures were 38.8% and 0.6% for men with initial PSA ≤10ng/ml, and 64.4% and 21.4% for PSA >10ng/ml. The proportion of men untreated at final follow-up was similar in the two PSA groups (22% vs 23%). The use of sextant biopsy for many years of the trial is a limitation. CONCLUSIONS: Men with an initial benign prostate biopsy run a very low risk of dying from PC when participating in a screening program. However, if followed for a long period, many men will be diagnosed and treated for PC. Low-intensity follow-up, as in the Göteborg trial, appears sufficient for men with PSA ≤10ng/ml after a benign biopsy. PATIENT SUMMARY: This study shows that men who participate in a prostate cancer screening trial have a low risk of dying from prostate cancer if the first biopsy does not show cancer.
BACKGROUND: The optimal follow-up regimen for men after a benign prostate biopsy remains unknown. OBJECTIVE: To investigate long-term outcomes for men after an initial benign prostate biopsy. DESIGN, SETTING, AND PARTICIPANTS: All men with a benign biopsy in the first screening round of the Göteborg prostate cancer (PC) screening trial were included. The follow-up period was January 1, 1995-May 15, 2017. INTERVENTION: Prostate-specific antigen (PSA) tests were performed every second year (upper median age limit 69yr). Men with PSA ≥3ng/ml underwent prostate biopsy (sextant biopsy up to 2009). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The 20-yr cumulative PC incidence and PC mortality were calculated using the 1 minus Kaplan-Meier method. RESULTS AND LIMITATIONS: Of 452 men with a benign biopsy and followed for a median of 21.1yr, 169 were diagnosed with PC and five died from PC. The 20-yr cumulative PC incidence and PC mortality were 40.0% and 1.4%, respectively. The corresponding figures were 38.8% and 0.6% for men with initial PSA ≤10ng/ml, and 64.4% and 21.4% for PSA >10ng/ml. The proportion of men untreated at final follow-up was similar in the two PSA groups (22% vs 23%). The use of sextant biopsy for many years of the trial is a limitation. CONCLUSIONS:Men with an initial benign prostate biopsy run a very low risk of dying from PC when participating in a screening program. However, if followed for a long period, many men will be diagnosed and treated for PC. Low-intensity follow-up, as in the Göteborg trial, appears sufficient for men with PSA ≤10ng/ml after a benign biopsy. PATIENT SUMMARY: This study shows that men who participate in a prostate cancer screening trial have a low risk of dying from prostate cancer if the first biopsy does not show cancer.
Authors: Sandra Miriam Kawa; Hein Vincent Stroomberg; Signe Benzon Larsen; John Thomas Helgstrand; Birgitte Grønkær Toft; Andrew Julian Vickers; Klaus Brasso; Martin Andreas Røder Journal: J Urol Date: 2022-02-25 Impact factor: 7.600