1821 GLEASON UPGRADING AND INCREASED CANCER VOLUME ON REPEAT PROSTATE BIOPSY IN PATIENTS ON ACTIVE SURVEILLANCE

You have accessJournal of UrologyProstate Cancer: Localized IX1 Apr 20121821 GLEASON UPGRADING AND INCREASED CANCER VOLUME ON REPEAT PROSTATE BIOPSY IN PATIENTS ON ACTIVE SURVEILLANCE Robert Carrasquillo, Mark Preston, John Coen, Anthony Zietman, Matthew Smith, Chin-Lee Wu, W. Scott McDougal, and Adam Feldman Robert CarrasquilloRobert Carrasquillo Boston, MA More articles by this author , Mark PrestonMark Preston Boston, MA More articles by this author , John CoenJohn Coen Boston, MA More articles by this author , Anthony ZietmanAnthony Zietman Boston, MA More articles by this author , Matthew SmithMatthew Smith Boston, MA More articles by this author , Chin-Lee WuChin-Lee Wu Boston, MA More articles by this author , W. Scott McDougalW. Scott McDougal Boston, MA More articles by this author , and Adam FeldmanAdam Feldman Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1887AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The choice to terminate active surveillance (AS) for localized prostate cancer in favor of initiating definitive treatment is based on a variety of factors. These may include pathologic change on re-biopsy, progression in PSA or DRE, or patient preference. The relative extent to which each of these factors plays a role in the termination of AS is not clearly established. Our objective was to determine the prevalence of prostate re-biopsy and subsequent pathologic change in an AS cohort. METHODS Under IRB approved protocol, a historical cohort study of men diagnosed with prostate cancer was performed at a single tertiary-care center between 1991 and 2011. Although AS had been practiced throughout this period, in 2008 our group agreed upon a protocol for repeat biopsy at 12-18 months after diagnosis. Subsequent biopsy was left to the discretion of the treating physician. Only men with active surveillance as the initial management option were included. RESULTS The median follow-up was 4.5 years for the 623 patients included in the study. Median PSA at diagnosis was 5.1 ng/mL. 96.2% (600/623) of patients were Gleason 6, 3.7% (23/623) were Gleason 7 and 89.9% (561/623) were stage T1c. 378 (60.1%) patients underwent re-biopsy. The number of re-biopsies ranged from 1 – 7 with 125 (33.1%) patients having more than one re-biopsy. Findings on initial re-biopsy revealed prostate cancer in 70.9% (268/378), benign tissue in 21.2% (80/378), PIN in 6.4% (24/378), and atypia in 1.6% (6/378). The Gleason sum increased in 17.9% of patients whose re-biopsy revealed cancer. Cancer volume increased (expressed as percentage of positive cores in quartiles) in 25.7% of patients on re-biopsy. Of 149 patients who required active treatment, 45.0% (67/149) was due to pathologic progression. CONCLUSIONS We identified a significant proportion of Gleason upgrading and volume progression on repeat biopsy in this cohort. Repeat biopsy often resulted in a significant change in management of our AS population. These findings support the critical role of repeat biopsy in an AS protocol. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e736 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Carrasquillo Boston, MA More articles by this author Mark Preston Boston, MA More articles by this author John Coen Boston, MA More articles by this author Anthony Zietman Boston, MA More articles by this author Matthew Smith Boston, MA More articles by this author Chin-Lee Wu Boston, MA More articles by this author W. Scott McDougal Boston, MA More articles by this author Adam Feldman Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...