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. 2023 Jun;26(2):403-409.
doi: 10.1038/s41391-022-00582-x. Epub 2022 Aug 25.

Risk of progression following a negative biopsy in prostate cancer active surveillance

Kerri Beckmann  1   2 , Aida Santaolalla  3 , Mikio Sugimoto  4 , Peter Carroll  5 , Jose Rubio  6 , Arnauld Villers  7 , Anders Bjartell  8 , Todd Morgan  9 , Prokar Dasgupta  10   11 , Mieke Van Hemelrijck  3 , Oussama Elhage  10   11 ; Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium
Affiliations

Risk of progression following a negative biopsy in prostate cancer active surveillance

Kerri Beckmann et al. Prostate Cancer Prostatic Dis. 2023 Jun.

Abstract

Background: Currently, follow-up protocols are applied equally to men on active surveillance (AS) for prostate cancer (PCa) regardless of findings at their initial follow-up biopsy. To determine whether less intensive follow-up is suitable following negative biopsy findings, we assessed the risk of converting to active treatment, any subsequent upgrading, volume progression (>33% positive cores), and serious upgrading (grade group >2) for negative compared with positive findings on initial follow-up biopsy.

Methods: 13,161 men from 24 centres participating in the Global Action Plan Active Surveillance Prostate Cancer [GAP3] consortium database, with baseline grade group ≤2, PSA ≤ 20 ng/mL, cT-stage 1-2, diagnosed after 1995, and ≥1 follow-up biopsy, were included in this study. Risk of converting to treatment was assessed using multivariable mixed-effects survival regression. Odds of volume progression, any upgrading and serious upgrading were assessed using mix-effects binary logistic regression for men with ≥2 surveillance biopsies.

Results: 27% of the cohort (n = 3590) had no evidence of PCa at their initial biopsy. Over 50% of subsequent biopsies in this group were also negative. A negative initial biopsy was associated with lower risk of conversion (adjusted hazard ratio: 0.45; 95% confidence interval [CI]: 0.42-0.49), subsequent upgrading (adjusted odds ratio [OR]: 0.52; 95%CI: 0.45-0.62) and serious upgrading (OR: 0.74; 95%CI: 0.59-92). Radiological progression was not assessed due to limited imaging data.

Conclusion: Despite heterogeneity in follow-up schedules, findings from this global study indicated reduced risk of converting to treatment, volume progression, any upgrading and serious upgrading among men whose initial biopsy findings were negative compared with positive. Given the low risk of progression and high likelihood of further negative biopsy findings, consideration should be given to decreasing follow-up intensity for this group to reduce unnecessary invasive biopsies.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Risk of transitioning to treatment while on active surveillance according to whether initial follow-up biopsy findings were positive or negative for prostate cancer.
Fig. 2
Fig. 2. Grading classification at each repeat biopsy according to initial follow-up biopsy findings among men on active surveillance.
A Negative 1st biopsy. B Postivive 1st biopsy. Bx biopsy, GG Grade group.
See this image and copyright information in PMC

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