662 THE SIGNIFICANCE OF FINDING NO PROSTATE CANCER ON THE ACTIVE SURVEILLANCE CONFIRMATORY BIOPSY: IMPLICATIONS FOR PATHOLOGICAL RE-CLASSIFICATION

Abstract

You have accessJournal of UrologyProstate Cancer: Localized (III)1 Apr 2013662 THE SIGNIFICANCE OF FINDING NO PROSTATE CANCER ON THE ACTIVE SURVEILLANCE CONFIRMATORY BIOPSY: IMPLICATIONS FOR PATHOLOGICAL RE-CLASSIFICATION Lih-Ming Wong, Greg Trottier, Nathan Lawrentschuk, Narhari Timilshina, Girish Kulkarni, Robert Hamilton, John Trachtenberg, Alexandre Zlotta, Ants Toi, Neil Fleshner, and Antonio Finelli Lih-Ming WongLih-Ming Wong Toronto, Canada More articles by this author , Greg TrottierGreg Trottier Toronto, Canada More articles by this author , Nathan LawrentschukNathan Lawrentschuk Toronto, Canada More articles by this author , Narhari TimilshinaNarhari Timilshina Toronto, Canada More articles by this author , Girish KulkarniGirish Kulkarni Toronto, Canada More articles by this author , Robert HamiltonRobert Hamilton Toronto, Canada More articles by this author , John TrachtenbergJohn Trachtenberg Toronto, Canada More articles by this author , Alexandre ZlottaAlexandre Zlotta Toronto, Canada More articles by this author , Ants ToiAnts Toi Toronto, Canada More articles by this author , Neil FleshnerNeil Fleshner Toronto, Canada More articles by this author , and Antonio FinelliAntonio Finelli Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.217AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A significant proportion of men are consistently reported to have no cancer on the 2nd, also known as the confirmatory, biopsy (B2) for active surveillance (AS). Intuitively, this group of men may have lower volume disease and could benefit from less intensive follow up. We investigate if men on AS with no cancer found at B2, are less likely to undergo subsequent pathological re-classification. METHODS Patients were identified from our tertiary care referral centre AS database (1997-2012). Eligibility criteria were PSA ≤10, clinical stage ≤T2, ≤ 3 positive cores involved, no core >50% involved and age ≤75. Patients who did not undergo a 3rd or subsequent biopsy, because of either ceasing AS after the 2nd biopsy or having insufficient follow up, were excluded. The patients on AS with ≥3 biopsies (n=286) were dichotomized on the basis of cancer status (yes or no) at B2. A Cox proportional hazards model was used to examine if absence of cancer at B2 was a predictor for re-classification. Pathological re-classification was defined as grade (GS ≥7) and/or volume (PCores >3, >50% single core involved). Re-classification free probability estimates were calculated by the Kaplan-Meier method and comparisons between curves made by the log rank test. RESULTS Of the 286 patients analysed at B2, 149 (52%) had no cancer and 137 (48%) had cancer satisfying eligibility criteria to remain on AS. The median follow-up for our cohort was 41 months, (IQR 26.5-61.9). The proportion of patients that re-classified on subsequent biopsies were 23.5% (no cancer group) and 40.1% (cancer group). The most common method of re-classification for the no cancer group was grade-only (48.6%), whereas for the cancer group, volume-only re-classification (41.8%) occurred the most frequently. The probability of remaining free of pathological re-classification at 2 and 5 years, stratified by cancer status on B2, for the no cancer group was 96.6% and 85.2% and the cancer group 92.7% and 67.3% respectively (log rank, p=0.002). No cancer at B2 was associated with a 54% reduction in risk of subsequent re-classification (HR 0.46, p=0.002). Increasing age (HR 1.06, p=0.001) and PSA density (HR 1.49, p=0.04) were predictors of re-classification. CONCLUSIONS Absence of cancer on the 2nd biopsy is associated with a significant decreased risk of pathological re-classification. When re-classification does occur, it tends to be grade-related. Hence, whilst frequency of re-biopsy could be reduced in this group, re-biopsy remains an essential component of follow-up in all patients on AS. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e270-e271 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lih-Ming Wong Toronto, Canada More articles by this author Greg Trottier Toronto, Canada More articles by this author Nathan Lawrentschuk Toronto, Canada More articles by this author Narhari Timilshina Toronto, Canada More articles by this author Girish Kulkarni Toronto, Canada More articles by this author Robert Hamilton Toronto, Canada More articles by this author John Trachtenberg Toronto, Canada More articles by this author Alexandre Zlotta Toronto, Canada More articles by this author Ants Toi Toronto, Canada More articles by this author Neil Fleshner Toronto, Canada More articles by this author Antonio Finelli Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...