Outcomes of grade group 2 and 3 prostate cancer on initial versus confirmatory biopsy: Implications for active surveillance Journal Article


Authors: Perera, M.; Jibara, G.; Tin, A. L.; Haywood, S.; Sjoberg, D. D.; Benfante, N. E.; Carlsson, S. V.; Eastham, J. A.; Laudone, V.; Touijer, K. A.; Fine, S.; Scardino, P. T.; Vickers, A. J.; Ehdaie, B.
Article Title: Outcomes of grade group 2 and 3 prostate cancer on initial versus confirmatory biopsy: Implications for active surveillance
Abstract: Background: Active surveillance (AS) is recommended as the preferred treatment for men with low-risk disease. In order to optimize risk stratification and exclude undiagnosed higher-grade disease, most AS protocols recommend a confirmatory biopsy. Objective: We aimed to compare outcomes among men with grade group (GG) 2/3 prostate cancer on initial biopsy with those among men whose disease was initially GG1 but was upgraded to GG2/3 on confirmatory biopsy. Design, setting, and participants: We reviewed patients undergoing radical prostatectomy (RP) in two cohorts: “immediate RP group,” with GG2/3 cancer on diagnostic biopsy, and “AS group,” with GG1 cancer on initial biopsy that was upgraded to GG2/3 on confirmatory biopsy. Outcome measurements and statistical analysis: Probabilities of biochemical recurrence (BCR) and salvage therapy were determined using multivariable Cox regression models with risk adjustment. Risks of adverse pathology at RP were also compared using logistic regression. Results and limitations: The immediate RP group comprised 4009 patients and the AS group comprised 321 patients. The AS group had lower adjusted rates of adverse pathology (27% vs 35%, p = 0.003). BCR rates were lower in the AS group, although this did not reach conventional significance (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.50–1.06, p = 0.10) compared with the immediate RP group. Risk-adjusted 1- and 5-yr BCR rates were 4.6% (95% CI 3.0–6.5%) and 10.4% (95% CI 6.9–14%), respectively, for the AS group compared with 6.3% (95% CI 5.6–7.0%) and 20% (95% CI 19–22%), respectively, in the immediate RP group. A nonsignificant association was observed for salvage treatment–free survival favoring the AS group (HR 0.67, 95% CI 0.42, 1.06, p = 0.087). Conclusions: We found that men with GG1 cancer who were upgraded on confirmatory biopsy tend to have less aggressive disease than men with the same grade found at initial biopsy. These results must be confirmed in larger series before recommendations can be made regarding a more conservative approach in men with upgraded pathology on surveillance biopsy. Patient summary: We studied men with low-risk prostate cancer who were initially eligible for active surveillance but presented with more aggressive cancer on confirmatory biopsy. We found that outcomes for these men were better than the outcomes for those diagnosed initially with more serious cancer. © 2022
Keywords: adult; controlled study; aged; middle aged; major clinical study; salvage therapy; cancer grading; cohort analysis; tumor biopsy; pathology; biopsy; prostate cancer; prostatic neoplasms; prostate; prostatectomy; active surveillance; watchful waiting; prostate tumor; biochemical recurrence; clinical outcome; procedures; oncological outcomes; neoplasm grading; humans; prognosis; human; male; article; initial biopsy; treatment free survival; gleason pattern; confirmatory biopsy
Journal Title: European Urology Focus
Volume: 9
Issue: 4
ISSN: 2405-4569
Publisher: Elsevier B.V.  
Date Published: 2023-07-01
Start Page: 662
End Page: 668
Language: English
DOI: 10.1016/j.euf.2022.12.008
PUBMED: 36566100
PROVIDER: scopus
PMCID: PMC10285029
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Behfar Ehdaie -- Source: Scopus
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MSK Authors
  1. Vincent Laudone
    138 Laudone
  2. Peter T Scardino
    671 Scardino
  3. Karim Abdelkrim Touijer
    259 Touijer
  4. Andrew J Vickers
    887 Vickers
  5. Daniel D. Sjoberg
    234 Sjoberg
  6. Behfar Ehdaie
    175 Ehdaie
  7. James Eastham
    540 Eastham
  8. Samson W Fine
    463 Fine
  9. Sigrid Viktoria Carlsson
    221 Carlsson
  10. Nicole E Benfante
    161 Benfante
  11. Amy Lam Ling Tin
    116 Tin
  12. Ghalib Jibara
    7 Jibara
  13. Marlon Lakmal Perera
    24 Perera