Low-Risk PCa Diagnosed on Repeat Biopsy More Favorable

Patients are less likely to have Gleason upgrading and extracapsular extension.
Patients are less likely to have Gleason upgrading and extracapsular extension.

ORLANDO—Men diagnosed with low-risk prostate cancer (PCa) based on a repeat prostate biopsy are less likely have adverse oncologic findings after radical prostatectomy (RP) compared with those diagnosed with low-risk PCa on initial biopsy, according to study findings presented at the American Urological Association 2014 annual meeting.

The findings provide important clinical guidance of men eligible for active surveillance (AS), researchers concluded.

Ahmed El-Shafei, MD, and colleagues at Cleveland Clinic identified 544 patients eligible for AS who underwent RP and divided them into 2 groups. One group included 375 men diagnosed with PCa on initial biopsy and the other group included 169 men diagnosed on repeat biopsy. The 2 groups were similar with respect to clinical and demographic characteristics.

Patients diagnosed with PCa on repeat biopsy had significantly lower disease volume (lower median number of positive cores and lower maximum percent cancer involvement per core). A significantly higher proportion of patients diagnosed with PCa on initial biopsy had Gleason upgrading (to Gleason 7 or higher) and extraprostatic extension after RP than those diagnosed on repeat biopsy (58.7% vs. 41.8% and 13.9% vs. 7.3%, respectively).

The researchers considered patients to have low-risk PCa if they had T1c/T2a tumors, a PSA level less than 10 ng/mL, and a Gleason score of 6 or less. 

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