Men with transrectal ultrasound guided prostate biopsies (TRUS-Bx) have a high false-negative rate, and thus men with a negative TRUS-Bx frequently undergo repeat biopsies, possibly leading to subsequent diagnoses of prostate cancer (PCa). Long-term outcome data on such patients are sparse. The objective of the study was to determine both the long-term rates of PCa diagnosis and all-cause mortality in a large, population-based cohort of men with a single negative TRUS-Bx.
The study population included over 90000 men who had an initially negative TRUS-Bx in Ontario, Canada between April 1994 and March 2015. All men were older than 40 years and had no prior history of PCa. Mean age at date of first negative TRUS-Bx was 63.55 years (SD 8.75). Mean follow-up per patient was 7.86 years (SD 5.37). 42% of the entire cohort underwent at least one repeat prostate biopsy. Out of the patients who were diagnosed with PCa, over 70% underwent an additional biopsy, 20% had at least 2 additional biopsies and almost 10% had 3 or more biopsies.
The 1, 5, 10, 15, and 20-year cumulative incidence rates of PCa diagnosis were 4.4%, 13%, 18%, 22% and 24% respectively. Among the 15,690 patients diagnosed with PCa, 34% underwent radical prostatectomy, 20% were treated with radiotherapy, 14% with hormonal therapy and 32% received no active treatment (were either in active surveillance or watchful waiting protocols). The 5, 10, 15, and 20-year PCa and all-cause mortality rates were 0.2%, 0.6%, 1.3%, 1.8% and 5.7%, 15%, 28% and 44%, respectively. The PCa specific 20 year mortality rises with age from 0.2% in men aged 40-49, up to 6.9% in those aged 80 and above.
In summary, after 20 years of follow-up 24% will be diagnosed with PCa and 1.8% will die because of it. Dr. Sayyid concluded his interesting presentation by recommending that long term follow up of men at risk is warranted. Additionally, treatment strategies might need to be more aggressive in the elderly population diagnosed with prostate cancer.
Presented By: Rashid Sayyid, Toronto, Canada
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA