1779 REPEAT PROSTATE BIOPSIES IN MEN WITH LOW RISK PROSTATE CANCER IN A PROSPECTIVE ACTIVE SURVEILLANCE PROGRAM: FINDINGS AND CONSEQUENCES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111779 REPEAT PROSTATE BIOPSIES IN MEN WITH LOW RISK PROSTATE CANCER IN A PROSPECTIVE ACTIVE SURVEILLANCE PROGRAM: FINDINGS AND CONSEQUENCES Meelan Bul, Roderick van den Bergh, Xiaoye Zhu, Pim van Leeuwen, Monique Roobol, Fritz Schröder, and Chris Bangma Meelan BulMeelan Bul Rotterdam, Netherlands More articles by this author , Roderick van den BerghRoderick van den Bergh Rotterdam, Netherlands More articles by this author , Xiaoye ZhuXiaoye Zhu Rotterdam, Netherlands More articles by this author , Pim van LeeuwenPim van Leeuwen Rotterdam, Netherlands More articles by this author , Monique RoobolMonique Roobol Rotterdam, Netherlands More articles by this author , Fritz SchröderFritz Schröder Rotterdam, Netherlands More articles by this author , and Chris BangmaChris Bangma Rotterdam, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2129AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) protocols for low-risk prostate cancer (PC) generally include repeat prostate biopsies at predefined time points during follow-up. We studied the outcome of 1-year repeat biopsies and the predicting factors for possible risk reclassification in order to contribute to improve the inclusion strategy. METHODS We analyzed men with low-risk PC (clinical stage <=T2, PSA <=10 ng/ml, PSA density <0.2 ng/ml/ml, 1 or 2 positive biopsy cores and Gleason score <=6) included in a prospective AS protocol (PRIAS study) from December 2006 to October 2010. PSA was measured 3-monthly and the first, volume–dependent (prostate volume <40cc: 8 biopsy-cores, 40–60cc: 10, and >60cc: 12) repeat biopsy was scheduled 1 year after diagnosis. Risk reclassification towards high risk on repeat biopsy was defined as a Gleason score >7 or >3 positive biopsy cores. We assessed the relation of the baseline patient characteristics and PSA doubling time (PSA-DT) with reclassification towards high risk on repeat biopsy. RESULTS A total of 1482 patients were included. In 757 patients a first repeat biopsy was taken after a median follow-up of 1.03 yrs. Repeat biopsy showed favourable results (no or low-risk PC) in 594 patients (78.5%) and risk reclassification in 163 patients (21.5%). Multivariate logistic regression (table) showed the following baseline characteristics to have a significant relation to risk reclassification: number of initial positive cores (2 vs 1) (OR=1.8; p=0.002) and PSA density (OR=2.5; p=0.002). Age, clinical stage, total number of biopsy cores and PSA did not show significant results. Adding PSA-DT at the time of repeat biopsy as a predictor for high risk reclassification showed an increased risk for patients with PSA-DT <3 years (OR=1.8; p= 0.011). Table. Association of patient characteristics with risk reclassification on repeat biopsy. Baseline characteristics Baseline characteristics and PSA-DT OR (95% CI) P-value OR (95% CI) P-value Age at diagnosis 1.0 0.44 1.0 0.51 PSA 0.9 0.08 0.9 0.11 PSA-Dξ 2.1(1.3-3.4) 0.003⁎ 2.1(1.3-3.5) 0.003⁎ Clinical stage 1.1 0.79 1.1 0.66 Total biopsy cores 1.0 0.91 1.0 0.96 Positive cores 1.8(1.3-2.7) 0.001⁎ 1.8(1.2-2.6) 0.002⁎ PSA-DT <3 yr - - 1.7(1.1-2.5) 0.019⁎ PSA-DT 3-10 yr - - 1.4 0.12 ξ OR for PSA-D is reported per 0.10 units increase; ⁎ significant result (P <0.05) CONCLUSIONS The number of positive biopsy cores and PSA density at diagnosis are associated with risk reclassification towards high risk on repeat biopsy in our AS cohort. These characteristics potentially might be used as an indication for early re-staging biopsy. The relation between PSA-DT and repeat biopsy findings supports our protocol in which men with higher PSA-DT undergo more intensive biopsy schemes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e714 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Meelan Bul Rotterdam, Netherlands More articles by this author Roderick van den Bergh Rotterdam, Netherlands More articles by this author Xiaoye Zhu Rotterdam, Netherlands More articles by this author Pim van Leeuwen Rotterdam, Netherlands More articles by this author Monique Roobol Rotterdam, Netherlands More articles by this author Fritz Schröder Rotterdam, Netherlands More articles by this author Chris Bangma Rotterdam, Netherlands More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...