What is the risk of prostate cancer mortality following negative systematic TRUS-guided biopsies? A systematic review

Abstract

ObjectiveTo investigate the risk of prostate cancer-specific mortality (PCSM) following initial negative systematic transrectal ultrasound-guided (TRUS) prostate biopsies.DesignSystematic review.Data sourcesPubMed and Embase were searched using a string combination with keywords/Medical Subject Headings terms and free text in the search builder. Date of search was 13 April 2020.Study selectionStudies addressing PCSM following initial negative TRUS biopsies. Randomised controlled trials and population-based studies including men with initial negative TRUS biopsies reported in English from 1990 until present were included.Data extractionData extraction was done using a predefined form by two authors independently and compared with confirm data; risk of bias was assessed using the Newcastle–Ottawa Scale for cohort studies when applicable.ResultsFour eligible studies were identified. Outcomes were reported differently in the studies as both cumulative incidence and Kaplan-Meier estimates have been used. Regardless of the study differences, all studies reported low estimated incidence of PCSM of 1.8%–5.2% in men with negative TRUS biopsies during the following 10–20 years. Main limitation in all studies was limited follow-up.ConclusionOnly a few studies have investigated the risk of PCSM following initial negative biopsies and all studies included patients before the era of MRI of the prostate. However, the studies point to the fact that the risk of PCSM is low following initial negative TRUS biopsies, and that the level of prostate-specific antigen before biopsies holds prognostic information. This may be considered when advising patients about the need for further diagnostic evaluation.PROSPERO registration numberCRD42019134548.

Risk of prostate cancer and death after benign transurethral resection of the prostate—A 20‐year population‐based analysis

“…Our data show that the risk of prostate cancer–specific death is almost identical to the risk of prostate cancer–specific death in men with benign systematic TRUS biopsies. A recent review reported that the risk of prostate cancer–specific death after benign TRUS biopsies ranged from 0.5% to 5.2% after 10–20 years of follow‐up, and there was a strong association with PSA 18,19 . The current study shows that the cumulative incidence of prostate cancer mortality was up to 0.8% after 15 years in men with PSA levels <10 ng/ml; this was an even lower incidence than the incidence of 1.3% after a benign initial biopsy 20,21 .…”

“…A recent review reported that the risk of prostate cancer-specific death after benign TRUS biopsies ranged from 0.5% to 5.2% after 10-20 years of follow-up, and there was a strong association with PSA. 18,19 The current study shows that the cumulative incidence of prostate cancer mortality was up to 0.8% after 15 years in men with PSA levels <10 ng/ml; this was an even lower incidence than the incidence of 1.3% after a benign initial biopsy. 20,21 This difference may be explained by the selection of patients for TURP; specifically, patients who undergo TURP have lower PSA levels than men with a negative first biopsy.…”

“…However, doubt has been cast on whether these cancers are oncologically aggressive. We and other groups have shown that the long‐term risk of prostate cancer death in men with benign systematic biopsies is very low 18,21 ; if MRI targeting identifies many histologically defined Gleason score ≥ 7 tumors in a group of men with low prostate cancer mortality, it is clear that most of the tumors are in fact indolent despite their histology 10 . This suggests that current guidelines on how to histologically evaluate and grade MRI‐targeted biopsies may need revision.…”

Standardized prostate cancer incidence and mortality rates following initial non‐malignant biopsy result

“…There have been distressing clinical cases where the window of opportunity for cure was missed when an initial biopsy failed to detect an aggressive cancer. However, population-based data demonstrate that these cases are rare and that the first TRUS biopsy can separate patients into two very different prognostic groups based on whether the biopsy is malignant or non-malignant [1,2]. Patients with initial non-malignant TRUS biopsies have a very low risk of prostate cancer-specific mortality in the absence of other 'red flags', such as a high PSA level.…”

A Nationwide Analysis of Risk of Prostate Cancer Diagnosis and Mortality following an Initial Negative Transrectal Ultrasound Biopsy with Long-Term Followup

“…6 Thus, it is important to understand which patients with negative TRUS biopsy are at high risk of a missed lethal prostate cancer and, moreover, determine how TRUS re-biopsy performs in a population-based setting. 7–9 Here we build on our previously published result, including additional analysis of men with re-biopsies and extended followup. 8 We are particularly interested in mortality at 10–15 years as it seems unlikely, even given the prolonged lead time of prostate cancer, that failing to identify a cancer on TRUS biopsy would mean a missed opportunity for cure if mortality occurred more than 10–15 years subsequently.…”