Can confirmatory biopsy be omitted in patients with prostate cancer favorable diagnostic features on active surveillance? Journal Article


Authors: Satasivam, P.; Poon, B. Y.; Ehdaie, B.; Vickers, A. J.; Eastham, J. A.
Article Title: Can confirmatory biopsy be omitted in patients with prostate cancer favorable diagnostic features on active surveillance?
Abstract: Purpose We evaluated whether initial diagnostic parameters could predict the confirmatory biopsy result in patients initiating active surveillance for prostate cancer, to determine whether some men at low risk for disease reclassification could be spared unnecessary biopsy. Materials and Methods The cohort included 392 men with Gleason 6 prostate cancer on initial biopsy undergoing confirmatory biopsy. We used univariate and multivariable logistic regression to assess if high grade cancer (Gleason 7 or greater) on confirmatory biopsy could be predicted from initial diagnostic parameters (prostate specific antigen density, magnetic resonance imaging result, percent positive cores, percent cancer in positive cores and total tumor length). Results Median patient age was 62 years (IQR 56-66) and 47% of patients had a dominant or focal lesion on magnetic resonance imaging. Of the 392 patients 44 (11%) had high grade cancer on confirmatory biopsy, of whom 39 had Gleason 3+4, 1 had 4+3, 3 had Gleason 8 and 1 had Gleason 9 disease. All predictors were significantly associated with high grade cancer at confirmatory biopsy on univariate analysis. However, in the multivariable model only prostate specific antigen density and total tumor length were significantly associated (AUC 0.85). Using this model to select patients for confirmatory biopsy would generally provide a higher net benefit than performing confirmatory biopsy in all patients, across a wide range of threshold probabilities. Conclusions If externally validated, a model based on initial diagnostic criteria could be used to avoid confirmatory biopsy in many patients initiating active surveillance. © 2016 American Urological Association Education and Research, Inc.
Keywords: adult; human tissue; aged; major clinical study; case report; nuclear magnetic resonance imaging; cancer diagnosis; cancer grading; prostate specific antigen; biopsy; prostate cancer; gleason score; prostatic neoplasms; watchful waiting; prostate biopsy; cancer size; imaging; human; male; priority journal; article
Journal Title: Journal of Urology
Volume: 195
Issue: 1
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2016-01-01
Start Page: 74
End Page: 79
Language: English
DOI: 10.1016/j.juro.2015.07.078
PROVIDER: scopus
PUBMED: 26192258
PMCID: PMC4840176
DOI/URL:
Notes: Article -- Export Date: 3 February 2016 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Andrew J Vickers
    565 Vickers
  2. Behfar Ehdaie
    75 Ehdaie
  3. James Eastham
    427 Eastham
  4. Jessica Bing Ying Poon
    15 Poon