Is repeat prostatic biopsy in active surveillance a justifiable increase in workload for a district general hospital?

Abstract

Objectives: In February 2008 the National Institute for Clinical Excellence introduced guidelines for active surveillance of prostate cancer, with close monitoring including at least one set of repeat biopsies 12 months after diagnosis. We aim to establish the impact on workload caused by repeat biopsy rate in active surveillance and whether they impacted on management. Methods: We retrospectively reviewed all transrectal (TRUS) ultrasound biopsies ( n=1105) in our institution from 2009 to 2010 to determine which were repeat biopsies for active surveillance ( n=107). We reviewed the histology and case notes of these active surveillance patients to determine whether there was histological progression and change of management. Results: Some 9.7% ( n=107) of TRUS biopsies were for active surveillance. Histological disease progression (Gleason score 6 to ≥7) was seen in 32% ( n=23) cases. One patient (1%) developed locally advanced prostate cancer on restaging and was started on hormone therapy; 35% patients ( n=25) were changed from active surveillance to radical treatment post repeat biopsy. Conclusions: Repeat prostatic biopsy in active surveillance, although a considerable workload, has a justifiable outcome on treatment. One patient, who initially had intermediate-risk prostate cancer (Gleason 7) and had been preferentially offered radical treatment, developed incurable disease.