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.
UR - http://www.scopus.com/inward/record.url?scp=85137028586&partnerID=8YFLogxK
U2 - 10.1038/s41391-022-00582-x
DO - 10.1038/s41391-022-00582-x
M3 - Article
C2 - 36008540
AN - SCOPUS:85137028586
SN - 1365-7852
JO - PROSTATE CANCER AND PROSTATIC DISEASES
JF - PROSTATE CANCER AND PROSTATIC DISEASES
ER -