Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance Journal Article

   

Authors:	Berglund, R. K.; Masterson, T. A.; Vora, K. C.; Eggener, S. E.; Eastham, J. A.; Guillonneau, B. D.
Article Title:	Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance
Abstract:	Purpose: Active surveillance with selective delayed intervention is a treatment regimen used in patients with low risk prostate cancer. Decision making is based on pretreatment prostate specific antigen, clinical stage and prostate biopsy results. We reviewed our experience with immediate repeat biopsy in patients eligible for active surveillance with selective delayed intervention. Materials and Methods: A retrospective review was done of the records of consecutive patients who underwent repeat biopsy within 3 months of a first positive biopsy from March 2002 to June 2007. Patients were considered eligible if they had prostate specific antigen less than 10 ng/ml, clinical stage T2a or less, Gleason pattern 3 or less, 3 or fewer positive cores and no single core with 50% or greater cancer involvement. Results: A total of 104 patients met eligibility criteria. Of the 104 repeat biopsies performed 27 (26%) were negative, 59 (57%) had a Gleason score of 6 or less and 17 (16%) had a Gleason score of 7. One patient had a Gleason score of 9, while 10 of 104 (10%) had greater than 3 cores involved on repeat biopsy and 12 (12%) had 50% or greater involvement of at least 1 core. Of 104 cases (27%) 28 were upgraded and/or up staged. Treated cases that were upgraded and/or up staged were more likely to show higher pathological stage and grade at radical prostatectomy than those that were not (p = 0.003 and p = 0.001, respectively). Conclusions: Immediate repeat biopsy in cases of active surveillance with selective delayed intervention resulted in 27% being upgraded or up staged and those were more likely to show higher grade and stage disease at radical prostatectomy. We recommend repeat biopsy because it improved our discrimination of who are the best candidates for active surveillance with selective delayed intervention. © 2008 American Urological Association.
Keywords:	adult; controlled study; human tissue; aged; aged, 80 and over; middle aged; survival analysis; retrospective studies; major clinical study; cancer risk; cancer staging; follow-up studies; magnetic resonance imaging; cancer diagnosis; neoplasm staging; sensitivity and specificity; medical decision making; prostate specific antigen; cohort studies; medical record review; biopsy; time factors; risk assessment; prostate cancer; gleason score; prostate-specific antigen; prostatic neoplasms; prostate; prostatectomy; biopsy, needle; prostate biopsy; brachytherapy; cancer epidemiology; digital rectal examination; observation; monitoring, physiologic
Journal Title:	Journal of Urology
Volume:	180
Issue:	5
ISSN:	0022-5347
Publisher:	Elsevier Science, Inc.
Date Published:	2008-11-01
Start Page:	1964
End Page:	1968
Language:	English
DOI:	10.1016/j.juro.2008.07.051
PUBMED:	18801515
PROVIDER:	scopus
PMCID:	PMC2919316
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-53249155905&partnerID=40&md5=0d9495b00613e096451ebb466e477cf8
Notes:	--- - "Cited By (since 1996): 42" - "Export Date: 17 November 2011" - "CODEN: JOURA" - "Source: Scopus"

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