Abstract
Abstract
Purpose
To test any-cause discontinuation and ISUP GG upgrading rates during Active Surveillance (AS) in patients that underwent previous negative biopsies (PNBs) before prostate cancer (PCa) diagnosis vs. biopsy naive patients.
Methods
Retrospective analysis of 961 AS patients (2008–2020). Three definitions of PNBs were used: (1) PNBs status (biopsy naïve vs. PNBs); (2) number of PNBs (0 vs. 1 vs. ≥ 2); (3) histology at last PNB (no vs. negative vs. HGPIN/ASAP). Kaplan–Meier plots and multivariable Cox models tested any-cause and ISUP GG upgrading discontinuation rates.
Results
Overall, 760 (79.1%) vs. 201 (20.9%) patients were biopsy naïve vs. PNBs. Specifically, 760 (79.1%) vs. 138 (14.4%) vs. 63 (6.5%) patients had 0 vs. 1 vs. ≥ 2 PNBs. Last, 760 (79.1%) vs. 134 (13.9%) vs. 67 (7%) patients had no vs. negative PNB vs. HGPIN/ASAP. PNBs were not associated with any-cause discontinuation rates. Conversely, PNBs were associated with lower rates of ISUP GG upgrading: (1) PNBs vs. biopsy naïve (HR:0.6, p = 0.04); (2) 1 vs. 0 PNBs (HR:0.6, p = 0.1) and 2 vs. 0 PNBs, (HR:0.5, p = 0.1); (3) negative PNB vs. biopsy naïve (HR:0.7, p = 0.3) and HGPIN/ASAP vs. biopsy naïve (HR:0.4, p = 0.04). However, last PNB ≤ 18 months (HR:0.4, p = 0.02), but not last PNB > 18 months (HR:0.8, p = 0.5) were associated with lower rates of ISUP GG upgrading.
Conclusion
PNBs status is associated with lower rates of ISUP GG upgrading during AS for PCa. The number of PNBs and time from last PNB to PCa diagnosis (≤ 18 months) appear also to be critical for patient selection.
Publisher
Springer Science and Business Media LLC
Reference29 articles.
1. Mottet N, Bastian P, Bellmunt J et al (2020) Eau-Eanm-Estro-Esur-Siog: guidelines on prostate cancer. In: European Association of Urology. Eur Assoc Urol Guidelines Office, Arnhem, The Netherlands, pp 1–182
2. Bokhorst LP, Valdagni R, Rannikko A et al (2016) A decade of active surveillance in the prias study: an update and evaluation of the criteria used to recommend a switch to active treatment. Eur Urol 70:954–960. https://doi.org/10.1016/j.eururo.2016.06.007
3. Klotz L, Vesprini D, Sethukavalan P et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33:272–277. https://doi.org/10.1200/JCO.2014.55.1192
4. Moschini M, Carroll PR, Eggener SE et al (2017) Low-risk prostate cancer: identification, management, and outcomes. Eur Urol 72:238–249. https://doi.org/10.1016/j.eururo.2017.03.009
5. Tosoian JJ, Trock BJ, Landis P et al (2011) Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 29:2185–2190. https://doi.org/10.1200/JCO.2010.32.8112