MILAN—Negative second prostate biopsies in men on active surveillance (AS) for prostate cancer (PCa) does not rule out disease progression, according to data presented at the 28th annual congress of the European Association of Urology.

Lih-Ming Wong, MD, of the Division of Urologic Oncology, Princess Margaret Cancer Centre in Toronto, and collaborators studied 286 patients remaining on AS after a second—or confirmatory—prostate biopsy. Of these, the biopsy showed no cancer in 149 (52%) and cancer in 137 (48%). The median follow-up after the second biopsy was 41 months. Thirty-five patients (23.5%) in the no-cancer group had pathologic progression compared with 55 (40.1%) of the 137 patients with cancer. Progression-free survival at five years was 85.2% for the no-cancer group compared with 67.3% for the cancer group, Dr. Wong reported. These differences between the groups were statistically significant.

A negative second biopsy is associated with a 52% decreased overall risk of progression and a 64% decreased risk of volume-related progression. Additionally, the study showed that each per-unit increment in PSA density is associated with an overall 50% increased risk of progression and a 79% increased risk of volume-related progression. Only increasing age, however, predicted an increasing risk of grade-related progression.

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Dr. Wong and his colleagues concluded that biopsies in men with negative second biopsies cannot be completely abandoned or delayed, and clinicians should avoid being overly reassured by the absence of cancer on the second biopsy.

“Men with a negative confirmatory biopsy while on active surveillance are protected from volume-related progression but not grade-related progression, and this need to be taken into account when counseling men on active surveillance,” Dr. Wong said.