Prognostic Significance of a Negative Confirmatory Biopsy on Reclassification Among Men on Active Surveillance

• DOI: 10.1016/j.urology.2017.06.014
• Publication Date: 2017-06-16T07:45:50Z
• Authors: Vishnu Ganesan; Charles Dai; Yaw A. Nyame; Daniel J. Greene; Nima Almassi; Daniel Hettel; Joseph Zabell; Hans Arora; Samuel Haywood; Alice Crane; Chad Reichard; Anna Zampini; Ahmed Elshafei; Robert J. Stein; Khaled Fareed; J. Stephen Jones; Michael Gong; Andrew J. Stephenson; Eric A. Klein; Ryan K. Berglund
• Keywords: Male; Time Factors; Biopsy; Incidence; Prostate; Prostatic Neoplasms; Kaplan-Meier Estimate; Middle Aged; Prostate-Specific Antigen; Prognosis; Risk Assessment; 3. Good health; Survival Rate; 03 medical and health sciences; 0302 clinical medicine; Disease Progression; Humans; Neoplasm Grading; 10. No inequality; Aged; Follow-Up Studies; Ohio; Retrospective Studies

To examine the association between absence of disease on confirmatory biopsy and risk of pathologic reclassification in men on active surveillance (AS).Men with grade groups 1 and 2 disease on AS between 2002 and 2015 were identified who received a confirmatory biopsy within 1 year of diagnosis and ≥3 biopsies overall. The primary outcomes were pathologic reclassification by grade (any increase in primary Gleason pattern or Gleason score) or volume (>33% of sampled cores involved or increase in the number of cores with >50% involvement). The effect of a negative confirmatory biopsy survival was evaluated using Kaplan-Meier analysis and a Cox proportional hazards modeling.Out of 635 men, 224 met inclusion criteria (median follow-up: 55.8 months). A total of 111 men (49.6%) had a negative confirmatory biopsy. Decreased grade reclassification (69.7% vs 83.9%; P = .01) and volume reclassification (66.3% vs 87.4%; P = .004) was seen at 5 years for men with a negative confirmatory biopsy compared with those with a positive biopsy. On adjusted analysis, a negative confirmatory biopsy was associated with a decreased risk of grade reclassification (hazard ratio, 0.51; 95% confidence interval, 0.28-0.94; P = .03) and volume reclassification (hazard ratio, 0.32; 95% confidence interval, 0.17-0.61; P = .0006) at a median of 4.7 years.Absence of cancer on the confirmatory biopsy is associated with a significant decrease in rate of grade and volume reclassification among men on AS. This information may be used to better counsel men on AS.