AUA 2013 - Session Highlights: Should staging transrectal saturation biopsy be a standard for assessment of disease progression and follow up for prostate cancer patients on active surveillance?

SAN DIEGO, CA USA (UroToday.com) - A small number of patients on active surveillance for prostate cancer may progress due to occult areas of high-grade cancer missed on standard extended prostate biopsy (EB, ≤ 14 cores). Saturation biopsy (SB, ≥ 20 cores) may lead to more through sampling of the prostate and reduce the risk of missed high-grade cancers.

auaThe authors reviewed 485 prostate biopsies (288-EB; 197-SB) from 383 patients diagnosed with PCa on AS protocol from 2000-2011 to assess predictors of cancer progression and compared the ability of each template to identify Gleason ≥ 7 disease, > 2 core involvement and > 50% cancer involvement in each core. On multivariate analysis, SB identified higher Gleason (≥ 7) disease (p=0.04) and number of positive cores (> 2 cores).

The authors recommend using SB as a standard protocol for patients on AS, reducing the risk of missing factors that predict progression in patients on AS. Moderator, John Davis, MD cautions the increase in number of positive cores may represent sampling error due to repeated biopsy of the same area of the prostate cancer. On saturation biopsy, upgrading to Gleason Gleason ≥ 7 diseases may be of more clinical utility for deciding which men should proceed to active treatment from active surveillance. Other difficulties with this approach include patient willingness to undergo SB, utilization of OR time for SB, and the increased health care costs associated with SB.

Presented by Ahmed Elshafei, Yonghong Li, Asmaa Hatem, Ayman Moussa, Shoshana Weiner, Andrew Stephenson, Anthony Avallone, and J. Stephen Jones at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

Reported for UroToday.com by Anthony T. Corcoran, MD

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