PURPOSE: In AS for low risk PCa, we assessed whether saturation or transperineal biopsy altered medium-term oncologic outcomes compared with standard transrectal biopsy.
MATERIALS AND METHODS: Retrospective analysis of prospectively collected data from two cohorts with localised PCa (1998-2012) undergoing AS. PCa-specific, metastasis-free and treatment-free survival, unfavourable disease and significant cancer at RP were compared for standard (6-12 core, median 10) versus saturation (>12 core, median 16), and transrectal versus transperineal biopsy, using multivariate analysis.
RESULTS: 650 men analysed; Median (mean) follow-up of 55 (67) months. PCa-specific, metastasis-free and BCR-free survival were 100%, 100% and 99% respectively. Radical treatment-free survival at 5 and 10 years were 57% and 45% respectively (median time to treatment 7.5 years). On KM analysis, saturation biopsy was associated with increased objective biopsy progression requiring treatment (Log Rank x2 =5.87, p=0.01). On multivariate PH analysis, saturation biopsy (HR=1.68, p< 0.01) but not transperineal approach (p=0.89) was associated with increased objective biopsy progression requiring treatment. On logistic regression analysis of 179 men who underwent RP for objective progression, transperineal biopsy was associated with lower likelihood of unfavourable RP pathology (OR=0.42, p=0.03) but saturation biopsy did not alter the likelihood (p=0.25). Neither transperineal or saturation biopsy altered the likelihood of significant versus insignificant cancer at RP (p=0.19 and p=0.41 respectively).
CONCLUSIONS: Active surveillance achieved satisfactory oncologic outcomes. Saturation biopsy increased progression to treatment on AS; longer follow-up is needed to determine if this represents beneficial earlier detection of significant disease or over-treatment. Transperineal biopsy reduced the likelihood of unfavourable disease at RP, possibly due to earlier detection of anterior tumours.
Written by:
Thompson JE, Hayen A, Landau A, Haynes AM, Kalapara A, Ischia J, Matthews J, Frydenberg M, Stricker PD. Are you the author?
St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia; Garvan Institute of Medical Research & Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
Reference: BJU Int. 2014 Jul 2. Epub ahead of print.
doi: 10.1111/bju.12858
PubMed Abstract
PMID: 24989062
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