SAN DIEGO, CA USA (UroToday.com) - Investigators from Canada suggest that no cancer on second biopsy in men on active surveillance portends a good prognosis and may require less intensive follow-up.
In this study, the authors examined if men on AS (eligibility criteria - PSA ≤ 10, clinical stage ≤ T2, ≤ 3 positive cores involved, no core > 50% involved and age ≤ 75) with no cancer found at repeat biopsy were less likely to undergo subsequent pathological re-classification. Reviewing their tertiary care referral center AS database (1997-2012), patients on AS with ≥ 3 biopsies (n=286) were reviewed for the presence or absence of cancer at the 2nd biopsy. At a median follow-up of 41months, 52% had no cancer and 48% had cancer. The proportions of patients that progressed on subsequent biopsies were 23.5% (no cancer group) and 40.1% (cancer group).
Stratified by cancer status on re-biopsy, the probability of remaining free of pathological re-classification at 2 and 5 years was 96.6% and 85.2%, and the cancer group 92.7% and 67.3% respectively. No detectable cancer on second biopsy reduced the risk of subsequent progression by 54%.
The authors concluded that absence of cancer on the second biopsy was associated with a significant decrease in risk of pathological re-classification (most often manifesting as upgrading). These findings indicate that the frequency of future biopsies on AS could be calibrated in men with no cancer on second biopsy but warn that complete omission of re-biopsy is inappropriate, since progression does occur.
Abstract Title: The significance of finding no prostate cancer on the active surveillance confirmatory biopsy: Implications for pathological re-classification
Presented by Lih-Ming Wong, Greg Trottier, Nathan Lawrentschuk, Narhari Timilshina, Girish Kulkarni, Robert Hamilton, John Trachtenberg, Alexandre Zlotta, Ants Toi, Neil Fleshner, Antonio Finelli 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