PURPOSE: We investigate the frequency of cancer and pathological progression found in transition zone (TZ) biopsies in men undergoing multiple re-biopsy while on AS.
MATERIALS AND METHODS: Our tertiary center AS prostate cancer database (1997-2012) has eligibility criteria: PSA ≤ 10, ≤ cT2, no Gleason grade 4 or 5, ≤ 3 positive cores, no core >50% involved, age ≤ 75 years and having ≥1 biopsy after initial diagnostic biopsy. For analysis, men with total < 10 cores at diagnostic biopsy (B1), and/or a confirmatory biopsy (B2) >24 months after B1, were excluded. Multiparametric magnetic resonance imaging was performed selectively to investigate incongruity between PSA and biopsy findings. Pathological progression was defined as grade and/or volume (>50% core involved). TZ progression was subdivided into exclusive-TZ (only TZ) and combination TZ (both TZ and PZ). A multivariate Cox proportional hazards model examined for predictors of TZ progression.
RESULTS: 392 men were considered, with a median follow-up of 45.5 months. At each biopsy during AS (B2-B5+), the frequency of TZ disease was: TZ positive cores (18.6-26.7%), all TZ-progression (5.9-11.1%) and exclusive TZ-progression (2.7-6.7%). Volume-related progression occurred more frequently than grade-related (n=24 versus 9). Predictors of exclusive-TZ progression were maximum % single core (HR 1.99, C.I. 1.30-3.04, p=0.002), and MRI reporting cancer (HR 3.19, C.I. 1.23-8.27, p=0.02).
CONCLUSIONS: Across multiple AS biopsies, 2.7-6.7% of men had TZ-exclusive progression. We recommend TZ biopsy be considered in all men at confirmatory biopsy. Subsequently, positive MRI findings or high % core involvement may be useful to identify patients at risk.
Written by:
Wong LM, Toi A, Van der Kwast T, Trottier G, Alibhai SM, Timilshina N, Evans A, Zlotta A, Fleshner N, Finelli A. Are you the author?
Department of Uro-oncology, Division of Surgical Oncology, Princess Margaret Cancer Center, University Health Network.
Reference: J Urol. 2014 Apr 14. pii: S0022-5347(14)03336-9.
doi: 10.1016/j.juro.2014.04.010
PubMed Abstract
PMID: 24742593
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