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

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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.

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Authors and Affiliations

  1. INSERM, U1189, ONCO-THAI, 59037, Lille, France

    Jonathan Olivier, Philippe Puech & Arnauld Villers

  2. Univ Lille, 59000, Lille, France

    Jonathan Olivier, Xavier Leroy, Philippe Puech & Arnauld Villers

  3. Department of Urology, CHRU Lille, Lille University, Lille, France

    Jonathan Olivier, Jean-Christophe Fantoni & Arnauld Villers

  4. Division of Surgery and Interventional Science, University College London, London, UK

    Veeru Kasivisvanathan

  5. Department of Urology, University College London Hospital, London, UK

    Veeru Kasivisvanathan

  6. Santé publique: Épidémiologie et Qualité des Soins, Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694, 59000, Lille, France

    Elodie Drumez

  7. Department of Pathology, CHRU Lille, Lille University, Lille, France

    Xavier Leroy

  8. Department of Radiology, CHRU Lille, Lille University, Lille, France

    Philippe Puech

Authors
  1. Jonathan Olivier
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  2. Veeru Kasivisvanathan
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  3. Elodie Drumez
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  4. Jean-Christophe Fantoni
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  5. Xavier Leroy
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  6. Philippe Puech
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  7. Arnauld Villers
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Correspondence to Jonathan Olivier.

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Olivier, J., Kasivisvanathan, V., Drumez, E. et al. Low-risk prostate cancer selected for active surveillance with negative MRI at entry: can repeat biopsies at 1 year be avoided? A pilot study. World J Urol 37, 253–259 (2019). https://doi.org/10.1007/s00345-018-2420-6

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  • DOI: https://doi.org/10.1007/s00345-018-2420-6

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