MP12-07 TARGETED BIOPSIES IN MEN ON ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: WHEN IS UPGRADING REALLY INCREASED RISK?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I1 Apr 2018MP12-07 TARGETED BIOPSIES IN MEN ON ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: WHEN IS UPGRADING REALLY INCREASED RISK? Daniël Osses, Jan Verbeek, Frank-Jan Drost, Monique Roobol, and Ivo Schoots Daniël OssesDaniël Osses More articles by this author , Jan VerbeekJan Verbeek More articles by this author , Frank-Jan DrostFrank-Jan Drost More articles by this author , Monique RoobolMonique Roobol More articles by this author , and Ivo SchootsIvo Schoots More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.394AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To reduce undergrading magnetic resonance imaging (MRI) and targeted biopsies (TBx) are increasingly used in men on active surveillance (AS) for low-risk prostate cancer (PCa). However, risk thresholds are not yet fully understood when MRI ± TBx strategy is used during AS. Its use could namely result in ′risk inflation′ where a PCa that is stable may be more accurately sampled at TBx and found to include higher risk features than when it would be sampled in a systematic way. We present the number of men on AS who upgrade to Gleason score (GS) 3+4, 4+3 and ≥4+4 PCa based on MRI ± TBx. METHODS Men on AS received an MRI at baseline (3 months after diagnosis), at confirmatory (first repeat) biopsy or at surveillance biopsy. If indicated (PI-RADS suspicion score ≥3) men underwent TBx using MRI-TRUS fusion. Biopsy outcomes were categorized to any PCa, GS 3+4, GS 4+3 and GS ≥4+4 PCa based on MRI ± TBx on a per-patient and on a per-lesion basis. RESULTS Between 2014 and 2017 our prospective clinical database consists of 331 men on AS with GS 3+3 PCa (median age 67 yr, interquartile range [IQR] 62-72; median PSA level 8.0 ng/ml, IQR 5.6-12). 198 men had a suspicious lesion (PI-RADS ≥3) on MRI (Table 1A). MRI ± TBx detected any PCa in 51% of all men and in 169/198 (85%) of men with a suspicious lesion. One out of four of all men showed GS upgrading (≥3+4); a positive MRI showed in 82/198 (41%) men GS upgrading, only 24/198 (12%) showed upgrading to GS ≥4+3 PCa. Any PCa was detected in 213/265 suspicious lesions (80%) in 198 men on AS (Table 1B). A total of 95/265 (36%) suspicious lesions showed GS upgrading; only 25/265 (9%) lesions showed upgrading to GS ≥4+3 PCa. The per-patient and per-lesion analyses showed similar results. Additional analysis at any time point of the MRI within the AS work-up did not result in significant differences between upgrading. CONCLUSIONS Based on a suspicious MRI and subsequently TBx 41% of men on AS showed upgrading from GS 3+3 to ≥3+4 PCa. The majority of these men was classified into low intermediate-risk disease (GS 3+4); it might be wrong to falsely encourage men to cease AS because of an apparent increase in risk (reclassification) rather than a true change in their cancer. Only 12% of men on AS showed upgrading to GS ≥4+3 PCa. These men may have a worse prognosis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e137 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniël Osses More articles by this author Jan Verbeek More articles by this author Frank-Jan Drost More articles by this author Monique Roobol More articles by this author Ivo Schoots More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...