PURPOSE: To evaluate whether bilateral prostate cancer detected at Active Surveillance (AS) enrollment is associated with progression to Grade Group ≥2 (GG2) and to compare the efficacy of combined targeted biopsy plus systematic biopsy (CBx) versus systematic biopsy (Sbx) or targeted biopsy (Tbx) alone to detect bilateral disease. METHODS: A prospectively-maintained database of patients referred to our institution from 2007-2020 was queried. The study cohort included all AS patients with GG1 on confirmatory Cbx and follow-up of at least one year. Cox proportional hazard analysis identified baseline characteristics associated with progression to GG ≥2 at any point throughout follow-up. RESULTS: Of 579 patients referred, 103 patients had GG1 on Cbx and were included in the study. 49/103 (47.6%) patients progressed to ≥GG2, with 30/72 (41.7%) patients with unilateral disease progressing and 19/31 (61.3%) patients with bilateral disease progressing. Median time to progression was 68 months vs. 52 months for unilateral and bilateral disease, respectively (p=0.006). Both PSA Density (HR 1.72, p=0.005) and presence of bilateral disease (HR 2.21, p=0.012) on confirmatory biopsy were associated with AS progression. At time of progression, GG and risk group were significantly higher in patients with bilateral versus unilateral disease. Cbx detected 16% more patients with bilateral disease than Sbx alone. CONCLUSION: Bilateral disease and PSA Density at confirmatory Cbx conferred greater risk of earlier AS progression. Cbx was superior to Sbx for identifying bilateral disease. AS risk-stratification protocols may benefit from including presence of bilateral disease and should use Cbx to detect bilateral disease.
PURPOSE: To evaluate whether bilateral prostate cancer detected at Active Surveillance (AS) enrollment is associated with progression to Grade Group ≥2 (GG2) and to compare the efficacy of combined targeted biopsy plus systematic biopsy (CBx) versus systematic biopsy (Sbx) or targeted biopsy (Tbx) alone to detect bilateral disease. METHODS: A prospectively-maintained database of patients referred to our institution from 2007-2020 was queried. The study cohort included all AS patients with GG1 on confirmatory Cbx and follow-up of at least one year. Cox proportional hazard analysis identified baseline characteristics associated with progression to GG ≥2 at any point throughout follow-up. RESULTS: Of 579 patients referred, 103 patients had GG1 on Cbx and were included in the study. 49/103 (47.6%) patients progressed to ≥GG2, with 30/72 (41.7%) patients with unilateral disease progressing and 19/31 (61.3%) patients with bilateral disease progressing. Median time to progression was 68 months vs. 52 months for unilateral and bilateral disease, respectively (p=0.006). Both PSA Density (HR 1.72, p=0.005) and presence of bilateral disease (HR 2.21, p=0.012) on confirmatory biopsy were associated with AS progression. At time of progression, GG and risk group were significantly higher in patients with bilateral versus unilateral disease. Cbx detected 16% more patients with bilateral disease than Sbx alone. CONCLUSION: Bilateral disease and PSA Density at confirmatory Cbx conferred greater risk of earlier AS progression. Cbx was superior to Sbx for identifying bilateral disease. AS risk-stratification protocols may benefit from including presence of bilateral disease and should use Cbx to detect bilateral disease.
Entities:
Keywords:
Multiparametric magnetic resonance imaging; active surveillance; prostate cancer
Authors: Yu Jiang; Travis J Meyers; Adaeze A Emeka; Lauren Folgosa Cooley; Phillip R Cooper; Nicola Lancki; Irene Helenowski; Linda Kachuri; Daniel W Lin; Janet L Stanford; Lisa F Newcomb; Suzanne Kolb; Antonio Finelli; Neil E Fleshner; Maria Komisarenko; James A Eastham; Behfar Ehdaie; Nicole Benfante; Christopher J Logothetis; Justin R Gregg; Cherie A Perez; Sergio Garza; Jeri Kim; Leonard S Marks; Merdie Delfin; Danielle Barsa; Danny Vesprini; Laurence H Klotz; Andrew Loblaw; Alexandre Mamedov; S Larry Goldenberg; Celestia S Higano; Maria Spillane; Eugenia Wu; H Ballentine Carter; Christian P Pavlovich; Mufaddal Mamawala; Tricia Landis; Peter R Carroll; June M Chan; Matthew R Cooperberg; Janet E Cowan; Todd M Morgan; Javed Siddiqui; Rabia Martin; Eric A Klein; Karen Brittain; Paige Gotwald; Daniel A Barocas; Jeremiah R Dallmer; Jennifer B Gordetsky; Pam Steele; Shilajit D Kundu; Jazmine Stockdale; Monique J Roobol; Lionne D F Venderbos; Martin G Sanda; Rebecca Arnold; Dattatraya Patil; Christopher P Evans; Marc A Dall'Era; Anjali Vij; Anthony J Costello; Ken Chow; Niall M Corcoran; Soroush Rais-Bahrami; Courtney Phares; Douglas S Scherr; Thomas Flynn; R Jeffrey Karnes; Michael Koch; Courtney Rose Dhondt; Joel B Nelson; Dawn McBride; Michael S Cookson; Kelly L Stratton; Stephen Farriester; Erin Hemken; Walter M Stadler; Tuula Pera; Deimante Banionyte; Fernando J Bianco; Isabel H Lopez; Stacy Loeb; Samir S Taneja; Nataliya Byrne; Christopher L Amling; Ann Martinez; Luc Boileau; Franklin D Gaylis; Jacqueline Petkewicz; Nicholas Kirwen; Brian T Helfand; Jianfeng Xu; Denise M Scholtens; William J Catalona; John S Witte Journal: HGG Adv Date: 2021-11-19
Authors: Benjamin H Press; Tashzna Jones; Olamide Olawoyin; Soum D Lokeshwar; Syed N Rahman; Ghazal Khajir; Daniel W Lin; Matthew R Cooperberg; Stacy Loeb; Burcu F Darst; Yingye Zheng; Ronald C Chen; John S Witte; Tyler M Seibert; William J Catalona; Michael S Leapman; Preston C Sprenkle Journal: Eur Urol Open Sci Date: 2022-02-11