Comparison of outcomes of different biopsy schedules among men on active surveillance for prostate cancer: An analysis of the G.A.P.3 global consortium database.

The optimal interval for repeat biopsy during active surveillance (AS) for prostate cancer is yet to be defined. This study examined whether risk of upgrading (to grade group ≥ 2) or risk of converting to treatment varied according to intensity of repeat biopsy using data from the GAP3 consortium's global AS database.

Intensity of surveillance biopsy schedules was categorized according to centers' protocols: (a) Prostate Cancer Research International Active Surveillance project (PRIAS) protocols with biopsies at years 1, 4, and 7 (10 centers; 7532 men); (b) biennial biopsies, that is, every other year (8 centers; 4365 men); and (c) annual biopsy schedules (4 centers; 1602 men). Multivariable Cox regression was used to compare outcomes according to biopsy intensity.

Out of the 13,508 eligible participants, 56% were managed according to PRIAS protocols (biopsies at years 1, 4, and 7), 32% via biennial biopsy, and 12% via annual biopsy. After adjusting for baseline characteristics, risk of converting to treatment was greater for those on annual compared with PRIAS biopsy schedules (hazard ratio [HR] = 1.66; 95% confidence interval [CI] = 1.51-1.83; p < 0.001), while risk of upgrading did not differ (HR = 0.96; 95% CI = 0.84-1.10).

Results suggest more frequent biopsy schedules may deter some men from continuing AS despite no evidence of grade progression.

The Prostate. 2022 Mar 07 [Epub ahead of print]

Kerri R Beckmann, Chris H Bangma, Jozien Helleman, Anders Bjartell, Peter R Carroll, Todd Morgan, Daan Nieboer, Aida Santaolalla, Bruce J Trock, Riccardo Valdagni, Monique J Roobol, Global Action Plan Active Surveillance Prostate Cancer [G.A.P.3] Consortium

Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, South Australia, Australia., Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands., Department of Translational Medicine, Skane University Hospital, Malmo, Sweden., Department of Urology, University of California San Francisco, San Francisco, California, USA., Michigan Urological Surgery Improvement Collaborative, University of Michigan, Ann Arbor, Michigan, USA., Translational Oncology and Urology Research, Kings College London, London, UK., The James Buchanan Brady Urological Institute, John Hopkins University, Baltimore, Maryland, USA., Radiation Oncology and Prostate Cancer Program, Istituto Nazionale Dei Tumori, Milano, Italy.

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