Abstract
ObjectivesTo evaluate how accurate a 12-core transrectal biopsy derived low-risk prostate cancer diagnosis is for an active surveillance programme by comparing the histological outcome with that from confirmatory transperineal sector biopsy.Subjects and methodsThe cohort included 166 men diagnosed with low volume Gleason score 3+3 prostate cancer on initial transrectal biopsy who also underwent a confirmatory biopsy. Both biopsy techniques were performed according to standard protocols and samples were taken for histopathology analysis. Subgroup analysis was performed according to disease severity at baseline to determine possible disease parameters of upgrading at confirmatory biopsy.ResultsAfter confirmatory biopsy, 34% demonstrated Gleason score upgrade, out of which 25% were Gleason score 3+4 and 8.5% primary Gleason pattern 4. Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found.ConclusionIn our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy. Furthermore 8.5% of these upgraders had a primary Gleason pattern 4. Our results together with previously published evidence highlight the need for the revision of current guidelines in prostate cancer diagnosis for the selection of men for active surveillance.
Highlights
Active surveillance (AS) is a management option for men with low risk prostate cancer (PCa)
Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found
In our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy
Summary
Active surveillance (AS) is a management option for men with low risk prostate cancer (PCa). The main advantage of AS is its low morbidity, but the existing nomograms based on one initial transrectal prostate biopsy alone have only modest accuracy in predicting the outcomes of these men managed by AS [1]. A recent systematic review estimated that men with PCa remain on AS between 2.2 and 5.4 years, with an estimated probability of discontinuation being 33% at five years and 55% at ten years. Discontinuation occurs because of either disease progression or patient’s anxiety [2]. Disease progression can potentially be avoided if high-risk disease is adequately assessed at the outset. Anxiety can be reduced by giving men with PCa more confidence about the low risk nature of their disease [3]
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