Low-risk prostate cancer selected for active surveillance with negative MRI at entry: can repeat biopsies at 1 year be avoided? A pilot study
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In patients considered for active surveillance (AS), the use of MRI and targeted biopsies (TB) at entry challenges the approach of routine “per protocol” repeat systematic biopsies (SB) at 1 year. This pilot study aimed to assess whether an approach of performing repeat biopsies only if PSA kinetics are abnormal would be safe and sufficient to detect progression.
Prospective single-centre study of 149 patients on AS with low-risk PCa, a negative MRI at entry, followed for a minimum of 12 months between 01/2007 and 12/2015. Group 1 (n = 78) patients had per-protocol 12-month repeat SB; group 2 (n = 71) patients did not. Surveillance tests for tumour progression were for both groups: for cause SB and MRI-TB biopsies if PSA velocity (PSA-V) > 0.75 ng/ml/year, or PSA doubling time (PSADT) < 3 years. The main objectives are to compare the 2-year rates of tumour progression and AS discontinuation between groups. The secondary objectives are to estimate the diagnostic power of PSA-V and PSA-DT, to predict the risk of tumour progression.
Overall, 21 out of 149 patients (14.1%) showed tumour progression, 17.1% for group 1 and 12.3% for group 2, and 31 (21.2%) discontinued AS at 2 years. There was no difference between the 2 groups (p = 0.56). The area under the PSA-V and PSADT curves to predict tumour progression was 0.92 and 0.83, respectively.
We did not find any significant difference for progression and AS discontinuation rate between the 2 groups. The PSA kinetic seems accurate as a marker of tumour progression. These results support the conduct of a multi-centre prospective trial to confirm these findings.
KeywordsProstate cancer Active surveillance MRI Repeat biopsy PSA kinetics
- 2.Klotz L (2010) Active surveillance for prostate cancer: patient selection and management. Curr Oncol Tor Ont 17(Suppl 2):S11–S17Google Scholar
- 4.Ouzzane A, Renard-Penna R, Marliere F, Mozer P, Olivier J, Barkatz J et al (2015) Magnetic resonance imaging targeted biopsy improves selection of patients considered for active surveillance for clinically low risk prostate cancer based on systematic biopsies. J Urol 194(2):350–356CrossRefGoogle Scholar
- 5.Thurtle D, Barrett T, Thankappan-Nair V, Koo B, Warren A, Kastner C et al (2018) Progression and treatment rates using an active surveillance protocol incorporating image-guided baseline biopsies and multiparametric magnetic resonance imaging monitoring for men with favourable-risk prostate cancer. BJU Int. https://doi.org/10.1111/bju.14166 Google Scholar
- 15.Soloway MS, Soloway CT, Williams S, Ayyathurai R, Kava B, Manoharan M (2008) Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience. BJU Int 101(2):165–169Google Scholar
- 16.Khatami A, Ali K, Aus G, Gunnar A, Damber J-E, Jan-Erik D et al (2007) PSA doubling time predicts the outcome after active surveillance in screening-detected prostate cancer: results from the European randomized study of screening for prostate cancer, Sweden section. Int J Cancer 120(1):170–174CrossRefGoogle Scholar