Risk of progression following a negative biopsy in prostate cancer active surveillance.
Journal
Prostate cancer and prostatic diseases
ISSN: 1476-5608
Titre abrégé: Prostate Cancer Prostatic Dis
Pays: England
ID NLM: 9815755
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
27
04
2022
accepted:
01
08
2022
revised:
26
07
2022
medline:
9
6
2023
pubmed:
26
8
2022
entrez:
25
8
2022
Statut:
ppublish
Résumé
Currently, follow-up protocols are applied equally to men on active surveillance (AS) for prostate cancer (PCa) regardless of findings at their initial follow-up biopsy. To determine whether less intensive follow-up is suitable following negative biopsy findings, we assessed the risk of converting to active treatment, any subsequent upgrading, volume progression (>33% positive cores), and serious upgrading (grade group >2) for negative compared with positive findings on initial follow-up biopsy. 13,161 men from 24 centres participating in the Global Action Plan Active Surveillance Prostate Cancer [GAP3] consortium database, with baseline grade group ≤2, PSA ≤ 20 ng/mL, cT-stage 1-2, diagnosed after 1995, and ≥1 follow-up biopsy, were included in this study. Risk of converting to treatment was assessed using multivariable mixed-effects survival regression. Odds of volume progression, any upgrading and serious upgrading were assessed using mix-effects binary logistic regression for men with ≥2 surveillance biopsies. 27% of the cohort (n = 3590) had no evidence of PCa at their initial biopsy. Over 50% of subsequent biopsies in this group were also negative. A negative initial biopsy was associated with lower risk of conversion (adjusted hazard ratio: 0.45; 95% confidence interval [CI]: 0.42-0.49), subsequent upgrading (adjusted odds ratio [OR]: 0.52; 95%CI: 0.45-0.62) and serious upgrading (OR: 0.74; 95%CI: 0.59-92). Radiological progression was not assessed due to limited imaging data. Despite heterogeneity in follow-up schedules, findings from this global study indicated reduced risk of converting to treatment, volume progression, any upgrading and serious upgrading among men whose initial biopsy findings were negative compared with positive. Given the low risk of progression and high likelihood of further negative biopsy findings, consideration should be given to decreasing follow-up intensity for this group to reduce unnecessary invasive biopsies.
Sections du résumé
BACKGROUND
Currently, follow-up protocols are applied equally to men on active surveillance (AS) for prostate cancer (PCa) regardless of findings at their initial follow-up biopsy. To determine whether less intensive follow-up is suitable following negative biopsy findings, we assessed the risk of converting to active treatment, any subsequent upgrading, volume progression (>33% positive cores), and serious upgrading (grade group >2) for negative compared with positive findings on initial follow-up biopsy.
METHODS
13,161 men from 24 centres participating in the Global Action Plan Active Surveillance Prostate Cancer [GAP3] consortium database, with baseline grade group ≤2, PSA ≤ 20 ng/mL, cT-stage 1-2, diagnosed after 1995, and ≥1 follow-up biopsy, were included in this study. Risk of converting to treatment was assessed using multivariable mixed-effects survival regression. Odds of volume progression, any upgrading and serious upgrading were assessed using mix-effects binary logistic regression for men with ≥2 surveillance biopsies.
RESULTS
27% of the cohort (n = 3590) had no evidence of PCa at their initial biopsy. Over 50% of subsequent biopsies in this group were also negative. A negative initial biopsy was associated with lower risk of conversion (adjusted hazard ratio: 0.45; 95% confidence interval [CI]: 0.42-0.49), subsequent upgrading (adjusted odds ratio [OR]: 0.52; 95%CI: 0.45-0.62) and serious upgrading (OR: 0.74; 95%CI: 0.59-92). Radiological progression was not assessed due to limited imaging data.
CONCLUSION
Despite heterogeneity in follow-up schedules, findings from this global study indicated reduced risk of converting to treatment, volume progression, any upgrading and serious upgrading among men whose initial biopsy findings were negative compared with positive. Given the low risk of progression and high likelihood of further negative biopsy findings, consideration should be given to decreasing follow-up intensity for this group to reduce unnecessary invasive biopsies.
Identifiants
pubmed: 36008540
doi: 10.1038/s41391-022-00582-x
pii: 10.1038/s41391-022-00582-x
pmc: PMC10247354
doi:
Substances chimiques
Prostate-Specific Antigen
EC 3.4.21.77
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
403-409Informations de copyright
© 2022. The Author(s).
Références
BMJ Open. 2019 Aug 22;9(8):e027860
pubmed: 31444180
BJU Int. 2018 May;121(5):737-744
pubmed: 29247473
BJU Int. 2021 Jul;128(1):72-78
pubmed: 33098158
Urology. 2017 Sep;107:184-189
pubmed: 28625591
Transl Androl Urol. 2018 Feb;7(1):83-97
pubmed: 29594023
BJU Int. 2021 Jan;127(1):96-107
pubmed: 32531869
Nat Rev Urol. 2021 Feb;18(2):77-78
pubmed: 33311651
Eur Urol Oncol. 2020 Feb;3(1):80-91
pubmed: 31564531
Transl Androl Urol. 2018 Feb;7(1):106-115
pubmed: 29594025
J Am Board Fam Med. 2012 Nov-Dec;25(6):763-70
pubmed: 23136314
J Urol. 2021 Jan;205(1):109-114
pubmed: 33198555
Oncotarget. 2017 Oct 24;8(65):108451-108462
pubmed: 29312542
Cancers (Basel). 2021 Aug 24;13(17):
pubmed: 34503059
Prostate. 2022 May;82(7):876-879
pubmed: 35254666
Eur Urol. 2015 Apr;67(4):627-36
pubmed: 25511988
Transl Androl Urol. 2021 Jun;10(6):2728-2736
pubmed: 34295758
Eur Urol. 2014 Sep;66(3):406-13
pubmed: 23664820
Eur Urol. 2015 Dec;68(6):1083-8
pubmed: 25819722
Eur Urol. 2015 Nov;68(5):822-3
pubmed: 26215607
Eur Urol. 2019 Nov;76(5):693-702
pubmed: 31451332
Eur Urol. 2018 May;73(5):706-712
pubmed: 29433973
J Urol. 2017 Apr;197(4):1014-1019
pubmed: 27836710
Eur Urol. 2013 Dec;64(6):876-92
pubmed: 23787356
Eur Urol. 2014 Aug;66(2):337-42
pubmed: 24035632
BJU Int. 2017 Jul;120(1):32-39
pubmed: 27611479
Eur Urol. 2013 Apr;63(4):597-603
pubmed: 23159452
Nat Rev Urol. 2016 Mar;13(3):151-67
pubmed: 26813955
Eur Urol. 2013 Mar;63(3):521-7
pubmed: 22704727
Eur Urol. 2020 Sep;78(3):443-451
pubmed: 32360049
Eur Urol. 2015 Nov;68(5):814-21
pubmed: 26138043