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World Journal of Urology

, Volume 37, Issue 2, pp 253–259 | Cite as

Low-risk prostate cancer selected for active surveillance with negative MRI at entry: can repeat biopsies at 1 year be avoided? A pilot study

  • Jonathan OlivierEmail author
  • Veeru Kasivisvanathan
  • Elodie Drumez
  • Jean-Christophe Fantoni
  • Xavier Leroy
  • Philippe Puech
  • Arnauld Villers
Topic Paper
  • 48 Downloads

Abstract

Purpose

In patients considered for active surveillance (AS), the use of MRI and targeted biopsies (TB) at entry challenges the approach of routine “per protocol” repeat systematic biopsies (SB) at 1 year. This pilot study aimed to assess whether an approach of performing repeat biopsies only if PSA kinetics are abnormal would be safe and sufficient to detect progression.

Methods

Prospective single-centre study of 149 patients on AS with low-risk PCa, a negative MRI at entry, followed for a minimum of 12 months between 01/2007 and 12/2015. Group 1 (n = 78) patients had per-protocol 12-month repeat SB; group 2 (n = 71) patients did not. Surveillance tests for tumour progression were for both groups: for cause SB and MRI-TB biopsies if PSA velocity (PSA-V) > 0.75 ng/ml/year, or PSA doubling time (PSADT) < 3 years. The main objectives are to compare the 2-year rates of tumour progression and AS discontinuation between groups. The secondary objectives are to estimate the diagnostic power of PSA-V and PSA-DT, to predict the risk of tumour progression.

Results

Overall, 21 out of 149 patients (14.1%) showed tumour progression, 17.1% for group 1 and 12.3% for group 2, and 31 (21.2%) discontinued AS at 2 years. There was no difference between the 2 groups (p = 0.56). The area under the PSA-V and PSADT curves to predict tumour progression was 0.92 and 0.83, respectively.

Conclusions

We did not find any significant difference for progression and AS discontinuation rate between the 2 groups. The PSA kinetic seems accurate as a marker of tumour progression. These results support the conduct of a multi-centre prospective trial to confirm these findings.

Keywords

Prostate cancer Active surveillance MRI Repeat biopsy PSA kinetics 

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.INSERM, U1189, ONCO-THAILilleFrance
  2. 2.Univ LilleLilleFrance
  3. 3.Department of UrologyCHRU Lille, Lille UniversityLilleFrance
  4. 4.Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
  5. 5.Department of UrologyUniversity College London HospitalLondonUK
  6. 6.Santé publique: Épidémiologie et Qualité des Soins, Department of BiostatisticsUniv. Lille, CHU Lille, EA 2694LilleFrance
  7. 7.Department of PathologyCHRU Lille, Lille UniversityLilleFrance
  8. 8.Department of RadiologyCHRU Lille, Lille UniversityLilleFrance

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