Age is associated with upgrading at confirmatory biopsy among men with prostate cancer treated with active surveillance Journal Article


Authors: Anderson, C. B.; Sternberg, I. A.; Karen-Paz, G.; Kim, P. H.; Sjoberg, D.; Vargas, H. A.; Touijer, K.; Eastham, J. A.; Ehdaie, B.
Article Title: Age is associated with upgrading at confirmatory biopsy among men with prostate cancer treated with active surveillance
Abstract: Purpose Active surveillance is increasingly recommended for older men with low risk prostate cancer. Although older men have higher all cause mortality, they also have higher prostate cancer specific mortality. We hypothesized that older age is associated with an increased risk of Gleason score upgrading at confirmatory biopsy when controlling for prostate volume. Materials and Methods We retrospectively reviewed data on 1,130 patients with prostate cancer who were treated with active surveillance from 1991 through 2011. We included 646 patients with clinical Gleason 6 or less, stage T2a or less prostate cancer, a confirmatory biopsy within 2 years of diagnostic biopsy and prostate magnetic resonance imaging before confirmatory biopsy. The primary outcome was Gleason score upgrading to 7 or greater on confirmatory biopsy. We used logistic regression to estimate the effect of age on upgrading, adjusting for magnetic resonance imaging prostate volume and other potential confounders. Results Median age was 66 years (IQR 61-72) and median magnetic resonance imaging prostate volume was 41 ml (IQR 29-55). At confirmatory biopsy disease was upgraded in 55 of 646 patients (9%) and unchanged in 290 (45%) and biopsy was negative in 297 (46%). Older age was associated with higher odds of upgrading (adjusted OR 1.05, 95% CI 1.01-1.09, p = 0.009). Larger prostate volume was associated with lower odds of upgrading (adjusted OR 0.80/10 ml increase, 95% CI 0.7-0.9, p = 0.012). Conclusions Our findings suggest that older age is associated with an increased risk of misclassification on diagnostic biopsy. Older men who are interested in active surveillance should be counseled about the risks and benefits of confirmatory biopsy. © 2015 American Urological Association Education and Research, Inc.
Keywords: adult; aged; major clinical study; cancer patient; nuclear magnetic resonance imaging; outcome assessment; magnetic resonance imaging; tumor volume; tumor biopsy; age factors; retrospective study; biopsy; prostate cancer; gleason score; prostatic neoplasms; watchful waiting; prostate biopsy; aging; prostate volume; human; male; priority journal; article
Journal Title: Journal of Urology
Volume: 194
Issue: 6
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2015-12-01
Start Page: 1607
End Page: 1611
Language: English
DOI: 10.1016/j.juro.2015.06.084
PROVIDER: scopus
PUBMED: 26119671
DOI/URL:
Notes: Export Date: 2 December 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Abdelkrim Karim Touijer
    190 Touijer
  2. Daniel D. Sjoberg
    139 Sjoberg
  3. Behfar Ehdaie
    73 Ehdaie
  4. James Eastham
    426 Eastham
  5. Philip Hyunwoo Kim
    39 Kim