Long-term Outcomes for Men in a Prostate Screening Trial with an Initial Benign Prostate Biopsy: A Population-based Cohort.

The optimal follow-up regimen for men after a benign prostate biopsy remains unknown.

To investigate long-term outcomes for men after an initial benign prostate biopsy.

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.

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).

The 20-yr cumulative PC incidence and PC mortality were calculated using the 1 minus Kaplan-Meier method.

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.

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.

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.

European urology oncology. 2019 Feb 13 [Epub ahead of print]

Emmeli Palmstedt, Marianne Månsson, Maria Frånlund, Johan Stranne, Carl-Gustaf Pihl, Jonas Hugosson, Rebecka Arnsrud Godtman

Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sweden. Electronic address: ., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Göteborg, Sweden., Department of Pathology, Institute of Biomedicine, Sahlgrenska Academy at University of Göteborg, Sweden.