MP69-14 THE RISK OF PROSTATE CANCER ON SUBSEQUENT BIOPSIES IN MEN WITH HIGH-GRADE PIN AND/OR ASAP IN A PROSPECTIVE STUDY WITH CENTRAL PATHOLOGY (THE REDUCE TRIAL)

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2014MP69-14 THE RISK OF PROSTATE CANCER ON SUBSEQUENT BIOPSIES IN MEN WITH HIGH-GRADE PIN AND/OR ASAP IN A PROSPECTIVE STUDY WITH CENTRAL PATHOLOGY (THE REDUCE TRIAL) Laura-Maria Krabbe and Claus G. Roehrborn Laura-Maria KrabbeLaura-Maria Krabbe More articles by this author and Claus G. RoehrbornClaus G. Roehrborn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2233AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High-grade prostatic intraepithelial neoplasia (HG PIN) and atypical small acinar proliferation (ASAP) are conditions found in around 5% of prostate biopsies without cancer and lead to frequent repeat biopsies. The rate of cancer (PCA) is 25% after PIN and as high as 40% after ASAP. However, factors predicting which patient will have PCA on repeat biopsy are lacking and therefore patient selection and timeframe for re-biopsy remain arbitrary. METHODS Post hoc subset analysis of patients participating in the REDUCE trial placebo arm. Patients considered at high risk for PCA after prior negative biopsy (without PCA, HG PIN or ASAP after central review) were included in REDUCE. Standardized 12 core biopsies were taken at 2 and 4 years. Prostate volume, PSA and free PSA levels were obtained regularly. Primary outcome measures were proportion of HG PIN and ASAP on the 1st post-baseline biopsy as well as proportion of PCA detected on follow-up biopsy after detection of HG PIN or ASAP. Secondary outcome measures were differences in baseline parameters and changes over time between patients with and without subsequent PCA on repeat biopsy after HG PIN or ASAP. RESULTS Overall, 4,126 patients were randomized to placebo out of which 2,367 underwent a 1st post-baseline biopsy. HG PIN and ASAP was detected in 109 (4.6%) and 116 (4.9%), respectively. On subsequent biopsies, 23 (21.1%) patients with previous HG PIN and 39 (33.6%) patients with previous ASAP were diagnosed with PCA. This compares to 244 (11.4%) patients without HG PIN or ASAP on 1st post baseline biopsy and a RR of 1.85 (95%CI 1.26-2.71) and 2.95 (95%CI 2.23-3.91) for detection of PCA after HG PIN and ASAP, respectively. Patients with subsequent PCA diagnosis had lower % of free PSA and lower prostate volume, whereas PSA levels were not different from patients without PCA diagnosis (table 1). CONCLUSIONS This study avoids selection and other provider biases. The RR of 2.95 for ASAP supports early repeat biopsy, while the RR of 1.85 for HGPIN in line with other series supports a more conservative approach. Risk of subsequent cancer follows predictable parameters and their changes over time in terms of prostate volume, PSA and %free PSA. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e820 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Laura-Maria Krabbe More articles by this author Claus G. Roehrborn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...