Risk of progression following a negative biopsy in prostate cancer active surveillance

The Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium

doi:10.1038/s41391-022-00582-x

Risk of progression following a negative biopsy in prostate cancer active surveillance

The Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium

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

Abstract

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.

Original language	English
Journal	PROSTATE CANCER AND PROSTATIC DISEASES
DOIs	https://doi.org/10.1038/s41391-022-00582-x
Publication status	Accepted/In press - 2022

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@article{b4fdba7610a042d791ecc65d585e4499,

title = "Risk of progression following a negative biopsy in prostate cancer active surveillance",

abstract = "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.",

author = "{The Movember Foundation{\textquoteright}s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium} and Kerri Beckmann and Aida Santaolalla and Mikio Sugimoto and Peter Carroll and Jose Rubio and Arnauld Villers and Anders Bjartell and Todd Morgan and Prokar Dasgupta and {Van Hemelrijck}, Mieke and Oussama Elhage",

note = "Funding Information: This work was supported by the Movember Foundation. Dr Kerri Beckmann is supported by a National Health and Medical Research Council (Australia) Sydney Sax Fellowship (Gnt#1124210). Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

doi = "10.1038/s41391-022-00582-x",

language = "English",

journal = "PROSTATE CANCER AND PROSTATIC DISEASES",

issn = "1365-7852",

publisher = "Nature Publishing Group",

}

TY - JOUR

T1 - Risk of progression following a negative biopsy in prostate cancer active surveillance

AU - The Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium

AU - Beckmann, Kerri

AU - Santaolalla, Aida

AU - Sugimoto, Mikio

AU - Carroll, Peter

AU - Rubio, Jose

AU - Villers, Arnauld

AU - Bjartell, Anders

AU - Morgan, Todd

AU - Dasgupta, Prokar

AU - Van Hemelrijck, Mieke

AU - Elhage, Oussama

N1 - Funding Information: This work was supported by the Movember Foundation. Dr Kerri Beckmann is supported by a National Health and Medical Research Council (Australia) Sydney Sax Fellowship (Gnt#1124210). Publisher Copyright: © 2022, The Author(s).

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

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U2 - 10.1038/s41391-022-00582-x

DO - 10.1038/s41391-022-00582-x

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JO - PROSTATE CANCER AND PROSTATIC DISEASES

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ER -

Risk of progression following a negative biopsy in prostate cancer active surveillance

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