Active surveillance (AS) for prostate cancer (PCa) relies on regular PSA tests and surveillance biopsies. Compliance rates with biopsies vary but the subsequent impact on oncologic outcomes is not known. The objective of this study was to determine whether non-compliance with the confirmatory biopsy negatively impacts PCa-specific outcomes.
A retrospective analysis was performed on a prospective single-arm cohort of men enrolled in AS for PCa between 1995 and 2018 with a median follow-up of 9.1 years. A total of 1,275 patients were enrolled and 1,043 patients had a minimum of three years of follow-up and were included in the analysis. Patients were stratified by compliance with a confirmatory biopsy within 24 months of enrollment in AS. The primary outcome was recurrence-free survival (RFS). Secondary outcomes included metastatic-free survival (MFS), and cause-specific survival (CSS).
A total of 1,275 patients were enrolled and 1,043 patients had a minimum of three years of follow-up and were included in the analysis, of which 425 were treated for localized PCa. Patients non-compliant with the confirmatory biopsy had higher rates of recurrence post-treatment (19% versus 12%, HR=1.64, 95% CI 1.19-2.26, p=0.003) and metastases (7% versus 2%, HR=3.56, 95% CI 1.8-7.0, p=0.0003) even after accounting for age, PSA, and Grade Group (GG). CSS was not significantly different between the two groups. The results were consistent even in the subset of patients with GG 1 at study entry.
Non-compliance with a confirmatory biopsy compromises the control of PCa in men followed on AS. Patients and physicians should be aware of the importance of adhering to protocol for men on AS.
The Journal of urology. 2020 Apr 24 [Epub ahead of print]
Jay S Detsky, Alireza Fotouhi Ghiam, Alexandre Mamedov, Kristina Commisso, Angela Commisso, Liying Zhang, Stanley Liu, Laurence Klotz, Andrew Loblaw, Danny Vesprini
Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Department of Radiation Oncology, BC Cancer Agency, Victoria, British Columbia, Canada., University Health Network, Toronto, Ontario, Canada., Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.