This article is more than 5 years old. Information may no longer be current.

Less frequent biopsies needed for men with low-risk prostate cancer undergoing active surveillance

For men undergoing active surveillance for low-risk prostate cancer, biennial biopsies may be a viable alternative to annual biopsies, according to new research published in Annals of Internal Medicine.

“Active surveillance is now the preferred approach for managing newly diagnosed, low-risk prostate cancer,” Lurdes Y.T. Inoue, PhD, from University of Washington, Seattle, and colleagues wrote. “A recent guideline from the American Society of Clinical Oncology supports the use of [active surveillance] for low-risk prostate cancer and provides recommendations about the target population and surveillance protocol. However, the recommendations lack specific information about how [active surveillance] should be implemented.”

Inoue and colleagues conducted a cross-cohort analysis of four large studies that evaluated active surveillance to compare longitudinal PSA levels and risks for biopsy upgrading using a joint statistical model. The researchers also evaluated the risk for upgrading from a Gleason score of six or less to seven or more after controlling for varying intervals and competing interests, as well as the consequences for more vs. less intensive biopsy frequency.

They analyzed the data of 2,576 men aged between 40 and 80 years who had a Gleason score between two and six, were clinically diagnosed with stage T1 or T2 prostate cancer and were enrolled in either the Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF) or University of Toronto (UT) active surveillance studies from 1995 and 2014.

Results indicated that while there were similar estimated risks for biopsy upgrading in the PASS and UT studies after accounting for differences in surveillance protocols and competing treatments, the risks were higher in the UCSF study and lower in the JHU study. Across all studies, there was a 3- to 5-month delay in the detection of upgraded cancer with biennial biopsies after an initial confirmatory biopsy compared with annual biopsies.

“Our analysis suggests that biennial rather than annual biopsies may be justified, particularly given the invasiveness and potential morbidity of annual biopsies,” Inoue and colleagues concluded. “This finding provides quantitative justification for the American Society of Clinical Oncology clinical practice guideline, which also recommends less frequent biopsies after a confirmatory biopsy within a year of entering [active surveillance]. Both that guideline and our analysis support less frequent biopsies for men receiving [active surveillance], which should reduce morbidity and complications of this conservative approach as it becomes further established as a preferred method for managing low-risk prostate cancer.” – by Alaina Tedesco

Disclosure: Inoue reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.