Standardized prostate cancer incidence and mortality rates following initial non-malignant biopsy result.

To compare the incidence of subsequent prostate cancer diagnosis and death following an initial non-malignant systematic TRUS biopsy to an age- and calendar-year matched population over a 20-year period.

This population-based analysis compares a cohort of all men with initial non-malignant TRUS biopsy in Denmark between 1995-2016 (N=37,231) to the Danish population matched by age and calendar year, obtained from the NORDCAN 9.1 database. Age and calendar year corrected standardized prostate cancer incidence (SIR) and prostate cancer-specific mortality ratios (SMR) were calculated and the heterogeneity between age groups assessed with the Cochran's Q.

Median time to censoring was 11 years, and 4,434 men were followed for more than 15 years. The corrected SIR was 5.2 (95%CI: 5.1-5.4) and corrected SMR was 0.74 (95%CI: 0.67-0.81). Estimates differed between age groups (P<0.001 for both) with a higher SIR and SMR among younger men.

Men with non-malignant TRUS biopsy have a much higher incidence of prostate cancer but a risk of prostate cancer death below the population average. This underlines that the oncological risk of cancers missed in the initial TRUS biopsy is low. Accordingly, attempts to increase sensitivity of initial biopsy are unjustified. Moreover, current follow-up after non-malignant biopsy is likely overaggressive, particularly in men over the age of 60.

BJU international. 2023 Feb 27 [Epub ahead of print]

Hein V Stroomberg, Marc C M Andersen, J Thomas Helgstrand, Signe Benzon Larsen, Andrew J Vickers, Klaus Brasso, Andreas Røder

Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.