UroToday - Role of Repeated Biopsy of the Prostate in Predicting Disease Progression in Patients with Prostate Cancer on Active Surveillance - Abstract

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Friday, 30 May 2008

Division

of Urology, Department of Surgery, McGill

University Health

Center, Montreal, Quebec, Canada.

Active

surveillance (AS) with deferred treatment is an established management option

for patients with prostate cancer and favorable clinical parameters. The impact

of repeat biopsy after diagnosis was examined in a cohort of men with prostate

cancer on AS.

In all,

186 men with prostate cancer with favorable parameters or who refused treatment

were conservatively managed by AS. Of these, 92 patients had at least 1 biopsy

after diagnosis. Patients were

followed every 3 to 6 months with prostate-specific antigen (PSA) and physical

examination and were offered rebiopsy annually or if there were any changes on

physical examination or in the PSA value. Disease progression while on AS was defined

as having >/=1 of the following: >/=cT2b disease, >/=3 positive cores,

>50% of cancer in at least 1 core, or a predominant Gleason pattern of 4 in

rebiopsies.

The

median age of the patients at the time of diagnosis was 67 years (range, 49-78

years). The median follow-up was 76 months (range, 20-169 months). Of the 92

patients who underwent repeat biopsies, 42 patients, 25 patients, 13 patients,

10 patients, and 2 patients had 1, 2, 3, 4, and 5 rebiopsies, respectively. A

total of 34 patients (36%) demonstrated disease progression on rebiopsy. The

first rebiopsy was positive for cancer in 48 patients (52.2%) and negative in

44 patients (47.8%). The 5-year actuarial progression-free probability was 82%

for patients with a negative first repeat biopsy compared with 50% for patients

with a positive first rebiopsy (P = .02). A PSA doubling time <67 months was

associated an increased risk of disease progression on biopsy.

Negative

rebiopsy in patients with prostate cancer on AS is associated with low-volume

disease. The result of first repeated biopsy appears to have a strong impact on

disease progression. Patients with a

positive first repeated biopsy should be considered for treatment. An intensive

biopsy protocol within the first 2 years is required to identify and treat

those patients.

Written

by

Al Otaibi M, Ross P, Fahmy N, Jeyaganth S, Trottier H, Sircar K, Bégin LR,

Souhami L, Kassouf W, Aprikian A, Tanguay S.

Reference

Cancer.

2008 May 16. Epub ahead of print.

doi:10.1002/cncr.23575

PubMed

Abstract

PMID:18484590