Serial biopsy of the prostate may increase histologic inflammation in the gland among prostate cancer (PCa) patients being managed with active surveillance, but this increase does not appear to be associated with cancer upgrading, according to a pilot study.

Allison Glass, MD, and collaborators at the University of California-San Francisco (UCSF) studied 56 PCa patients being managed with AS and who underwent two or more transrectal ultrasound-guided prostate needle biopsies. In adjusted analyses, increasing numbers of biopsies were associated with small but significant increases in maximum chronic inflammation scores but were not associated with significant changes in acute inflammation, the researchers reported online ahead of print in Prostate Cancer and Prostatic Disease.

Nineteen subjects (34%) experienced a Gleason score upgrade from 6 or less at diagnosis, 11 (56%) of these occurring at the second biopsy. The investigators observed no significant association between chronic inflammation and cancer upgrade.

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“Despite the study’s limitations and small size, we provide a relatively novel finding of a potential long-term outcome of repeated prostate needle biopsy,” the authors concluded.

Of the 56 patients, 41 (73%) had low-risk disease, 14 (25%) had intermediate-risk disease, and one (2%) had high-risk disease. Twenty patients had two biopsies, 10 had three, 14 had four, and 12 had five. For the study, all biopsy tissue slides underwent routine pathology evaluation by a UCSF genitourinary pathologist.

In their analysis of the association between repeat biopsies and chronic inflammation, the researchers adjusted for age, prostate volume, clinical risk, diagnostic PSA level, the presence of benign prostatic hyperplasia, and use of nonsteroidal anti-inflammatory drugs.