Prognosis of patient progression and outcomes on active surveillance


The prostate cancer research team led by Dr. Peter Pinto at the National Cancer Institute has just published some interesting new information on risk for disease progression in men on active surveillance.

The new paper by Bloom et al. in the Journal of Urology looked at the implications of a negative MRI/TRUS fusion biopsy (and the full text of this paper is accessible on line).

Bloom et al. looked at their data on a total of 542 patients who were started on active surveillance, all of whom were referred to the Urologic Oncology Branch at the National Cancer Institute (between 2007 and 2017) after initial diagnosis with prostate cancer (at other centers) and a Grade Group of either 1 or 2 (based on a standard, 12-core systematic, biopsy). What they wanted to investigate was whether men who subsequently had a negative repeat biopsy on an MRI/TRUS fusion biopsy had a better prognosis over time than the men who had a positive repeat biopsy.

Here are their core findings:

  • Of the 542 patients referred to the Urology Oncology Branch at the NCI
    • 466 patients (86.0 percent) had a Grade Group of 1.
    • 76 patients (14.0 percent) had a Grade Group of 2.
  • Average follow-up for all 542 patients was 43.6 months (range, 6.7 to 121.9 months)
  • All 542 patients were given a 3 T multiparametric MRI and then a confirmatory MRI/TRUS-guided fusion biopsy.
    • 110/466 patients (21.5 percent) with Grade Group 1 disease on initial biopsy had a negative fusion biopsy result and elected to remain on AS.
    • 10/76 patients (13.2 percent) with Grade Group 2 disease on initial biopsy had a negative fusion biopsy result and elected to remain on AS.
  • A total of 332/542 patients elected to remain on AS overall, including 146 men with a positive fusion biopsy result.
  • Among these 332 men, 182 (54.8 percent) went on to have a repeat (i.e., a second) MRI/TRUS-guided fusion biopsy.
    • 60/182 of these men had had a negative outcome from their first MRI/TRUS-guided biopsy.
    • 122/182 of these men had had a positive outcome from their first MRI/TRUS-guided biopsy.
    • 43/60 (71.7 percent) of men who had had a negative outcome from their initial MRI/TRUS-guided fusion biopsy also had a negative outcome from their repeat biopsy.
    • 71/122 (58.2 percent) of men who had had a positive outcome from their initial MRI/TRUS-guided fusion biopsy had not progressed at the time of their repeat biopsy.
  • An initial negative result on a confirmatory MRI/TRUS-guided fusion biopsy was associated with a significantly reduced risk of Grade Group progression (hazard ratio [HR] = 0.41) in this cohort of patients.

The authors conclude that:

A negative confirmatory fusion biopsy confers a favorable prognosis for Grade Group progression. These results can be used when counseling patients about the risk of progression and for planning future followup and biopsies in patients on active surveillance.

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