The Impact Of First Repeated Biopsy In Predicting Progression In A Cohort Of Prostate Cancer Patients Managed With Active Surveillance

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health
Article Date: 10 Sep 2007 - 0:00 PDT

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UroToday.com - Presented Monday, 03 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Active surveillance (AS) with deferred treatment is an established management option for patients with prostate cancer and favorable parameters. We have examined the impact of re-biopsy after diagnosis in a cohort of AS prostate cancer.

Methods: 186 men with prostate cancer with favorable parameters or refusing treatment were conservatively managed by AS. Of these, 92 patients had at least one biopsy after diagnosis. PSA and physical exam were done every 6 months and patients were offered re-biopsy annually. Progression was defined as having one or more of the following criteria on follow up; ≥c2b, ≥3 positive cores, >50% of cancer in at least one core or predominant Gleason pattern of 4 in re-biopsies.

Results: Median age at diagnosis was 67 (49-78) years. Median follow up was 76 (20-169) months. A total of 34(36%) patients had progression. Overall median time to progression was 18 months. The first re-biopsy was positive for cancer in 48 patients and negative in 44 patients. The 5-year actuarial progression free probability was 82% for patients with negative first re-biopsy compared to 50% of the patients with positive first re-biopsy (p=0.01) and, it was 97% for patients with persistent negative biopsy compared to 42% in patients with persistent positive biopsy (p<0.0001). One positive core and no core with more than 10% of cancer at diagnostic biopsy were predictive of negative re-biopsy. Prostate volume and >2 positive cores at diagnosis were significant predictor of progression. A total of 29 patients were treated. All of 10 patients treated by radical prostatectomy had or-gan-confined disease except one. 4 of the treated patients had post treatment failure in a median post treatment follow-up of 48 months.

Conclusions: Negative re-biopsy in patients with prostate cancer on AS is associated with low volume disease. The result of first repeated biopsy has strong impact in predicting disease progression. Patients with positive first re-biopsy should be considered for treatment. Pathological progression usually occurs in the first 2 years of follow up. Intensive biopsy protocol in the first 2-3 years is required to identify and to offer treatment to patients at high risk of progression.

Authors: Al Otaibi MF, Fahmy N, Ross P, Kassouf W, Jeyaganth S, Steinberg J, Begin LR, Sircar K, Aprikian A, Tanguay S

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