Negative first follow-up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment

Sohail Singh; Preeti Sandhu; Kerri Beckmann; Aida Santaolalla; Kamal Dewan; Sharon Clovis; Jonah Rusere; Grace Zisengwe; Benjamin Challacombe; Christian Brown; Paul Cathcart; Rick Popert; Prokar Dasgupta; Mieke Van Hemelrijck; Oussama Elhage

doi:10.1111/bju.15281

Negative first follow-up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment

Sohail Singh, Preeti Sandhu, Kerri Beckmann^*, Aida Santaolalla, Kamal Dewan, Sharon Clovis, Jonah Rusere, Grace Zisengwe, Benjamin Challacombe, Christian Brown, Paul Cathcart, Rick Popert, Prokar Dasgupta, Mieke Van Hemelrijck, Oussama Elhage

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Objective: To determine the risk of disease progression and conversion to active treatment following a negative biopsy while on active surveillance (AS) for prostate cancer (PCa). Patients and Methods: Men on an AS programme at a single tertiary hospital (London, UK) between 2003 and 2018 with confirmed low–intermediate-risk PCa, Gleason Grade Group <3, clinical stage <T3 and a diagnostic prostate-specific antigen (PSA) level of <20 ng/mL. This cohort included men diagnosed by transrectal ultrasonography guided (12–14 cores) or transperineal (median 32 cores) biopsy. Multivariate Cox hazards regression analysis was undertaken to determine (i) risk of upgrading, (ii) clinical or radiological suspicion of disease progression, and (iii) transitioning to active treatment. Suspicion of disease progression was defined as any biopsy upgrading, >30% positive cores, magnetic resonance imaging (MRI) Likert score >3/T3 or PSA level of >20 ng/mL. Conversion to treatment included radical or hormonal treatment. Results: Among the 460 eligible patients, 23% had negative follow-up biopsy findings. The median follow-up was 62 months, with one to two repeat biopsies and two MRIs per patient during that period. Negative biopsy findings at first repeat biopsy were associated with decreased risk of converting to active treatment (hazard ration [HR] 0.18, 95% confidence interval [CI] 0.09–0.37; P < 0.001), suspicion of disease progression (HR 0.56, 95% CI: 0.34–0.94; P = 0.029), and upgrading (HR 0.48, 95% CI 0.23–0.99; P = 0.047). Data are limited by fewer men with multiple follow-up biopsies. Conclusion: A negative biopsy finding at the first scheduled follow-up biopsy among men on AS for PCa was strongly associated with decreased risk of subsequent upgrading, clinical or radiological suspicion of disease progression, and conversion to active treatment. A less intense surveillance protocol should be considered for this cohort of patients.

Original language	English
Journal	BJU International
DOIs	https://doi.org/10.1111/bju.15281
Publication status	Accepted/In press - 2020

Keywords

#PCSM
#ProstateCancer
#uroonc
active surveillance
disease progression
prostate biopsy
prostate cancer
prostate-specific antigen
repeat biopsy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/bju.15281

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Singh, S., Sandhu, P., Beckmann, K., Santaolalla, A., Dewan, K., Clovis, S., Rusere, J., Zisengwe, G., Challacombe, B., Brown, C., Cathcart, P., Popert, R., Dasgupta, P., Van Hemelrijck, M., & Elhage, O. (Accepted/In press). Negative first follow-up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment. BJU International. https://doi.org/10.1111/bju.15281

@article{89d3d071347b4c4aacdb97bd554d4b74,

title = "Negative first follow-up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment",

abstract = "Objective: To determine the risk of disease progression and conversion to active treatment following a negative biopsy while on active surveillance (AS) for prostate cancer (PCa). Patients and Methods: Men on an AS programme at a single tertiary hospital (London, UK) between 2003 and 2018 with confirmed low–intermediate-risk PCa, Gleason Grade Group <3, clinical stage <T3 and a diagnostic prostate-specific antigen (PSA) level of <20 ng/mL. This cohort included men diagnosed by transrectal ultrasonography guided (12–14 cores) or transperineal (median 32 cores) biopsy. Multivariate Cox hazards regression analysis was undertaken to determine (i) risk of upgrading, (ii) clinical or radiological suspicion of disease progression, and (iii) transitioning to active treatment. Suspicion of disease progression was defined as any biopsy upgrading, >30% positive cores, magnetic resonance imaging (MRI) Likert score >3/T3 or PSA level of >20 ng/mL. Conversion to treatment included radical or hormonal treatment. Results: Among the 460 eligible patients, 23% had negative follow-up biopsy findings. The median follow-up was 62 months, with one to two repeat biopsies and two MRIs per patient during that period. Negative biopsy findings at first repeat biopsy were associated with decreased risk of converting to active treatment (hazard ration [HR] 0.18, 95% confidence interval [CI] 0.09–0.37; P < 0.001), suspicion of disease progression (HR 0.56, 95% CI: 0.34–0.94; P = 0.029), and upgrading (HR 0.48, 95% CI 0.23–0.99; P = 0.047). Data are limited by fewer men with multiple follow-up biopsies. Conclusion: A negative biopsy finding at the first scheduled follow-up biopsy among men on AS for PCa was strongly associated with decreased risk of subsequent upgrading, clinical or radiological suspicion of disease progression, and conversion to active treatment. A less intense surveillance protocol should be considered for this cohort of patients.",

keywords = "#PCSM, #ProstateCancer, #uroonc, active surveillance, disease progression, prostate biopsy, prostate cancer, prostate-specific antigen, repeat biopsy",

author = "Sohail Singh and Preeti Sandhu and Kerri Beckmann and Aida Santaolalla and Kamal Dewan and Sharon Clovis and Jonah Rusere and Grace Zisengwe and Benjamin Challacombe and Christian Brown and Paul Cathcart and Rick Popert and Prokar Dasgupta and {Van Hemelrijck}, Mieke and Oussama Elhage",

year = "2020",

doi = "10.1111/bju.15281",

language = "English",

journal = "BJU International",

issn = "1464-4096",

publisher = "Wiley-Blackwell",

}

Singh, S, Sandhu, P, Beckmann, K, Santaolalla, A, Dewan, K, Clovis, S, Rusere, J, Zisengwe, G, Challacombe, B , Brown, C, Cathcart, P, Popert, R, Dasgupta, P, Van Hemelrijck, M & Elhage, O 2020, 'Negative first follow-up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment', BJU International. https://doi.org/10.1111/bju.15281

TY - JOUR

T1 - Negative first follow-up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment

AU - Singh, Sohail

AU - Sandhu, Preeti

AU - Beckmann, Kerri

AU - Santaolalla, Aida

AU - Dewan, Kamal

AU - Clovis, Sharon

AU - Rusere, Jonah

AU - Zisengwe, Grace

AU - Challacombe, Benjamin

AU - Brown, Christian

AU - Cathcart, Paul

AU - Popert, Rick

AU - Dasgupta, Prokar

AU - Van Hemelrijck, Mieke

AU - Elhage, Oussama

PY - 2020

Y1 - 2020

N2 - Objective: To determine the risk of disease progression and conversion to active treatment following a negative biopsy while on active surveillance (AS) for prostate cancer (PCa). Patients and Methods: Men on an AS programme at a single tertiary hospital (London, UK) between 2003 and 2018 with confirmed low–intermediate-risk PCa, Gleason Grade Group <3, clinical stage <T3 and a diagnostic prostate-specific antigen (PSA) level of <20 ng/mL. This cohort included men diagnosed by transrectal ultrasonography guided (12–14 cores) or transperineal (median 32 cores) biopsy. Multivariate Cox hazards regression analysis was undertaken to determine (i) risk of upgrading, (ii) clinical or radiological suspicion of disease progression, and (iii) transitioning to active treatment. Suspicion of disease progression was defined as any biopsy upgrading, >30% positive cores, magnetic resonance imaging (MRI) Likert score >3/T3 or PSA level of >20 ng/mL. Conversion to treatment included radical or hormonal treatment. Results: Among the 460 eligible patients, 23% had negative follow-up biopsy findings. The median follow-up was 62 months, with one to two repeat biopsies and two MRIs per patient during that period. Negative biopsy findings at first repeat biopsy were associated with decreased risk of converting to active treatment (hazard ration [HR] 0.18, 95% confidence interval [CI] 0.09–0.37; P < 0.001), suspicion of disease progression (HR 0.56, 95% CI: 0.34–0.94; P = 0.029), and upgrading (HR 0.48, 95% CI 0.23–0.99; P = 0.047). Data are limited by fewer men with multiple follow-up biopsies. Conclusion: A negative biopsy finding at the first scheduled follow-up biopsy among men on AS for PCa was strongly associated with decreased risk of subsequent upgrading, clinical or radiological suspicion of disease progression, and conversion to active treatment. A less intense surveillance protocol should be considered for this cohort of patients.

AB - Objective: To determine the risk of disease progression and conversion to active treatment following a negative biopsy while on active surveillance (AS) for prostate cancer (PCa). Patients and Methods: Men on an AS programme at a single tertiary hospital (London, UK) between 2003 and 2018 with confirmed low–intermediate-risk PCa, Gleason Grade Group <3, clinical stage <T3 and a diagnostic prostate-specific antigen (PSA) level of <20 ng/mL. This cohort included men diagnosed by transrectal ultrasonography guided (12–14 cores) or transperineal (median 32 cores) biopsy. Multivariate Cox hazards regression analysis was undertaken to determine (i) risk of upgrading, (ii) clinical or radiological suspicion of disease progression, and (iii) transitioning to active treatment. Suspicion of disease progression was defined as any biopsy upgrading, >30% positive cores, magnetic resonance imaging (MRI) Likert score >3/T3 or PSA level of >20 ng/mL. Conversion to treatment included radical or hormonal treatment. Results: Among the 460 eligible patients, 23% had negative follow-up biopsy findings. The median follow-up was 62 months, with one to two repeat biopsies and two MRIs per patient during that period. Negative biopsy findings at first repeat biopsy were associated with decreased risk of converting to active treatment (hazard ration [HR] 0.18, 95% confidence interval [CI] 0.09–0.37; P < 0.001), suspicion of disease progression (HR 0.56, 95% CI: 0.34–0.94; P = 0.029), and upgrading (HR 0.48, 95% CI 0.23–0.99; P = 0.047). Data are limited by fewer men with multiple follow-up biopsies. Conclusion: A negative biopsy finding at the first scheduled follow-up biopsy among men on AS for PCa was strongly associated with decreased risk of subsequent upgrading, clinical or radiological suspicion of disease progression, and conversion to active treatment. A less intense surveillance protocol should be considered for this cohort of patients.

KW - #PCSM

KW - #ProstateCancer

KW - #uroonc

KW - active surveillance

KW - disease progression

KW - prostate biopsy

KW - prostate cancer

KW - prostate-specific antigen

KW - repeat biopsy

UR - http://www.scopus.com/inward/record.url?scp=85096715492&partnerID=8YFLogxK

U2 - 10.1111/bju.15281

DO - 10.1111/bju.15281

M3 - Article

C2 - 33098158

AN - SCOPUS:85096715492

SN - 1464-4096

JO - BJU International

JF - BJU International

ER -

Negative first follow-up prostate biopsy on active surveillance is associated with decreased risk of upgrading, suspicion of progression and converting to active treatment

Abstract

Keywords

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