Pathologic Upgrading And Upstaging With Immediate Repeat Biopsy For Patients Eligible For Active Surveillance

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Clinical Trials / Drug Trials
Article Date: 02 Jun 2008 - 4:00 PDT

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ORLANDO, FL (UroToday.com) - Active surveillance (AS) is an emerging treatment regimen used in patients with low-risk prostate cancer. Decision making is often based on pre-treatment PSA, clinical stage, and prostate biopsy results. Patients referred to a tertiary center often have biopsies that are heterogeneous in quantity and quality. A group from Memorial Sloan Kettering Cancer Center reports their experience with immediate repeat biopsy in patients eligible for AS.

They retrospectively reviewed consecutive patients undergoing repeat biopsy within 3 months of a first positive biopsy for the period between 2002 and 2007. Patients were considered eligible if they had a PSA < 10 ng/ml, clinical stage < T2b, Gleason grade <3, <3 cores positive, and no single core with >50% CaP involvement.

A total of 104 patients met the eligibility criteria. Of the repeat biopsies performed, 27/104 (26%) were negative, 58/104 (56%) had Gleason score <6, 17/104 (16%) had Gleason score 7, one patient had Gleason score 9, 10/104 (10%) of patients had > 3 cores involved on repeat biopsy, and 12/104 (12%) had > 50% involvement of at least one core. A total of 27/104 (26%) patients were upgraded or upstaged. Sixty patients eventually underwent surgery with no biochemical recurrences at a median follow-up of 13 months, except one patient who developed metastatic disease at 46 months following surgery.

Immediate repeat biopsy in patients with prostate cancer being considered for AS resulted in more than one quarter being upgraded or upstaged, thus yielding improved discrimination as to whom is the best candidate for AS. The majority of patients in this low-risk group eventually elected radical prostatectomy.

Presented by Ryan K Berglund, MD, Timothy A Masterson, MD, Kinjal C Vora, MD, Scott E Eggener, MD, James A Eastham, MD, and Bertrand D Guillonneau, MD at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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