Impact of Biopsy Compliance on Outcomes for Patients on Active Surveillance for Prostate Cancer.

Abstract

PURPOSE:

Active surveillance for prostate cancer relies on regular prostate specific antigen tests and surveillance biopsies. Compliance rates with biopsies vary but the subsequent impact on oncologic outcomes is not known. The objective of this study was to determine whether noncompliance with the confirmatory biopsy negatively impacts prostate cancer specific outcomes.

MATERIALS AND METHODS:

A retrospective analysis was performed on a prospective single-arm cohort of men enrolled in active surveillance for prostate cancer between 1995 and 2018 with a median followup of 9.1 years. A total of 1,275 patients were enrolled and 1,043 had a minimum of 3 years of followup and were included in the analysis. Patients were stratified by compliance with a confirmatory biopsy within 24 months of enrollment in active surveillance. The primary outcome was recurrence-free survival. Secondary outcomes included metastatic-free survival and cause specific survival.

RESULTS:

A total of 1,275 patients were enrolled, and 1,043 had a minimum of 3 years of followup and were included in the analysis, of whom 425 were treated for localized prostate cancer. Patients noncompliant with the confirmatory biopsy had higher rates of recurrence after treatment (19% vs 12%, HR 1.64, 95% CI 1.19-2.26, p=0.003) and metastases (7% vs 2%, HR 3.56, 95% CI 1.8-7.0, p=0.0003) even after accounting for age, prostate specific antigen and Grade Group. Cause specific survival was not significantly different between the 2 groups. The results were consistent even in the subset of patients with Grade Group 1 disease at study entry.

CONCLUSIONS:

Noncompliance with a confirmatory biopsy compromises the control of prostate cancer in men followed on active surveillance. Patients and physicians should be aware of the importance of adhering to protocol for men on active surveillance.

• Authors: Jay S Detsky, Alireza Fotouhi Ghiam, Alexandre Mamedov, Kristina Commisso, Angela Commisso, Liying Zhang, Stanley Liu, Laurence Klotz, Andrew Loblaw, Danny Vesprini
• Journal: The Journal of urology (J Urol) Vol. 204 Issue 5 Pg. 934-940 (11 2020) ISSN: 1527-3792 [Electronic] United States
• PMID: 32330406 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• KLK3 protein, human
• Kallikreins
• Prostate-Specific Antigen

Topics

• Aged
• Biopsy (statistics & numerical data)
• Disease Progression
• Disease-Free Survival
• Follow-Up Studies
• Humans
• Kallikreins (blood)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoplasm Recurrence, Local (blood, diagnosis, epidemiology, prevention & control)
• Patient Compliance (statistics & numerical data)
• Prospective Studies
• Prostate (pathology)
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms (blood, diagnosis, mortality, therapy)
• Retrospective Studies
• Watchful Waiting (methods, statistics & numerical data)