The Risk of Prostate Cancer Progression in Active Surveillance Patients with Bilateral Disease Detected by Combined Magnetic Resonance Imaging-Fusion and Systematic Biopsy

Abstract

Purpose: We sought to evaluate whether bilateral prostate cancer detected at active surveillance (AS) enrollment is associated with progression to Grade Group (GG) 2 and to compare the efficacy of combined targeted biopsy plus systematic biopsy (Cbx) vs systematic biopsy (Sbx) or targeted biopsy alone to detect bilateral disease. Materials and Methods: A prospectively maintained database of patients referred to our institution from 2007e2020 was queried. The study cohort included all AS patients with GG1 on confirmatory Cbx and followup of at least 1 year. Cox proportional hazard analysis identified baseline characteristics associated with progression to GG2 at any point throughout followup. Results: Of 579 patients referred, 103 patients had GG1 on Cbx and were included in the study; 49/103 (47.6%) patients progressed to GG2, with 30/72 (41.7%) patients with unilateral disease progressing and 19/31 (61.3%) patients with bilateral disease progressing. Median time to progression was 68 months vs 52 months for

Association Between a 22-feature Genomic Classifier and Biopsy Gleason Upgrade During Active Surveillance for Prostate Cancer

“…The setting of this study in the contemporary era of MRF-TB increases the generalizability of the results, as MRI is increasingly used to improve the initial assessment of cancer grade. However, it is important to note that prostate MRI does not eliminate the possibility of misclassification [5] . In this context, we found that baseline clinical parameters—including PSA density, number of cores positive for cancer, MRI findings, and age—offered only marginal discriminative ability for prediction of biopsy upgrading but were improved by the addition of the Decipher classifier.…”

“…Evidence from randomized trials and institutional cohort studies supports the long-term safety of active surveillance and its effectiveness as a strategy to avoid or defer definitive treatment [2] , [3] . Nonetheless, 20–60% of patients who are initially enrolled in active surveillance ultimately experience reclassification of their disease according to changes in biopsy Gleason grade, prostate-specific antigen (PSA) levels, or cancer volume [4] , [5] . As a result, up to half of patients undergo definitive treatment in the near term, most frequently because of Gleason upgrading [6] .…”

“…In this study we evaluated the association between Decipher genomic classifier scores and biopsy outcomes among patients with favorable-risk prostate cancer managed with initial active surveillance [14] . Analytic and clinical validation of commercially available genomic tests were largely conducted using archival tissue obtained in the era before widespread use of prostate magnetic resonance imaging (MRI), an approach that significantly improves the accuracy of sampling and reduces the risk of initial misclassification [5] , [15] , [16] . Therefore, commensurate with current clinical practice, we conducted our study in a contemporary cohort of patients managed with active surveillance following a prostate biopsy guided by MRI-ultrasound fusion.…”

Role of multi-parametric magnetic resonance imaging fusion biopsy in active surveillance of prostate cancer: a systematic review

“…The presence of bilateral disease has also been shown to increase the risk of progression on AS (HR = 3.06; 95% CI = 1.31–7.13), and combined FB and SB improve detection of bilateral disease than either method alone. 38 …”

This Month in Adult Urology

“…Surveillance Patients with Bilateral Disease Williams et al (page 1157) from Bethesda, Maryland retrospectively studied prediction of progression in patients on active surveillance and evaluated the impact of bilateral disease. 10 All patients had grade group I cancer on initial biopsy, and 41% with unilateral disease progressed on followup biopsy compared to 61% with bilateral disease. Progression was detected in 16% of patients with bilateral cancer using combined targeted plus systematic biopsies compared to targeted alone.…”