MP17-14 THE PROGNOSTIC IMPACT OF A NEGATIVE CONFIRMATORY BIOPSY IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2018MP17-14 THE PROGNOSTIC IMPACT OF A NEGATIVE CONFIRMATORY BIOPSY IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER Keyan Salari, Dimitar Zlatev, David Kuppermann, Mark Preston, Douglas Dahl, Jason Efstathiou, Michael Blute, Anthony Zietman, and Adam Feldman Keyan SalariKeyan Salari More articles by this author , Dimitar ZlatevDimitar Zlatev More articles by this author , David KuppermannDavid Kuppermann More articles by this author , Mark PrestonMark Preston More articles by this author , Douglas DahlDouglas Dahl More articles by this author , Jason EfstathiouJason Efstathiou More articles by this author , Michael BluteMichael Blute More articles by this author , Anthony ZietmanAnthony Zietman More articles by this author , and Adam FeldmanAdam Feldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.569AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) is increasingly used in managing low-risk and favorable intermediate-risk prostate cancer. To mitigate the risk of unsampled higher risk disease, most institutional AS protocols call for a confirmatory prostate biopsy within 12-18 months following initial diagnostic biopsy. Here, we investigate whether the results of confirmatory biopsy impact the outcomes of men on AS. METHODS We retrospectively reviewed our institutional database of men enrolled in AS between 1997-2014 with a minimum follow-up of 6 months (n = 974). Biopsies with any prostate cancer were considered positive. Biopsies containing only benign prostatic tissue, prostatic intraepithelial neoplasia (PIN), or atypical small acinar proliferation (ASAP) were considered negative. Statistical analysis was conducted using the Kaplan-Meier method and Cox proportional hazards regression. RESULTS At diagnosis, median age was 67 years (IQR 62-72) and median PSA was 5.1 ng/mL (IQR 3.9-6.8). The vast majority of patients had Gleason ≤6 (97%) and clinical stage T1 (92%) disease. With a median follow-up of 4.8 years, 702 (72%) patients underwent a confirmatory biopsy. 67% of confirmatory biopsies were positive for prostate cancer; 33% were negative (167 benign, 40 PIN, and 22 ASAP). Of the 702 patients, 33% progressed to treatment, with pathologic progression the most common reason (77%). Univariate predictors of progression to treatment included initial clinical stage (P=0.04), involvement of >20% of any core on diagnostic biopsy (P <0.01), PSA density ≥0.15 (P <0.001), and confirmatory biopsy status (P <10-14). In multivariate analysis, a negative confirmatory biopsy remained the strongest predictor of progression to treatment (HR 0.12 [95%CI 0.06-0.24], P < 10-8). Confirmatory biopsy status was not associated with risk of adverse pathology on RP, metastasis-free survival, disease-specific survival, or overall survival. CONCLUSIONS A negative confirmatory biopsy is associated with a significantly lower rate of progression to treatment among men on AS. This may serve as a useful tool for prognostication and help determine the need for further repeat biopsies for men on AS. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e210 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Keyan Salari More articles by this author Dimitar Zlatev More articles by this author David Kuppermann More articles by this author Mark Preston More articles by this author Douglas Dahl More articles by this author Jason Efstathiou More articles by this author Michael Blute More articles by this author Anthony Zietman More articles by this author Adam Feldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...