139 THE RATE OF UPGRADING AND UPSTAGING ON IMMEDIATE REPEAT BIOPSY IN PATIENTS ELIGIBLE FOR ACTIVE SURVEILLANCE IS NOT RELATED TO EXTENT OF FIRST BIOPSY (2010)

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2010139 THE RATE OF UPGRADING AND UPSTAGING ON IMMEDIATE REPEAT BIOPSY IN PATIENTS ELIGIBLE FOR ACTIVE SURVEILLANCE IS NOT RELATED TO EXTENT OF FIRST BIOPSY David S. Yee, Ari Adamy, Rodrigo Pinochet, Alexandra C. Maschino, Angel M. Cronin, Bertrand Guillonneau, Peter T. Scardino, and James Eastham David S. YeeDavid S. Yee More articles by this author , Ari AdamyAri Adamy More articles by this author , Rodrigo PinochetRodrigo Pinochet More articles by this author , Alexandra C. MaschinoAlexandra C. Maschino More articles by this author , Angel M. CroninAngel M. Cronin More articles by this author , Bertrand GuillonneauBertrand Guillonneau More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , and James EasthamJames Eastham More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.191AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repeated biopsy after a diagnosis of prostate cancer has been used as a method to better identify patients for active surveillance. With the change in the biopsy scheme from 6 to 12 cores, the role of the second biopsy began to be questioned. The aims of this study were to evaluate the rate of upstaging and/or upgrading after a repeated biopsy for active surveillance, and to investigate the association between the extent of the initial biopsy and whether the rebiopsy confirmed that these patients were candidates for active surveillance. METHODS From March 1993 to April 2009, 531 patients were referred to MSKCC as potential candidates for active surveillance. All patients met the inclusion criteria which consisted of PSA less than 10ng/ml, Gleason score 6 or less, cT2a or less, 3 or less positive cores and no more than 50% of a core involved by tumor. 297 patients had an immediate second biopsy (within 6 months of initial biopsy) with at least 10 cores taken. Cases were considered upgraded or upstaged if they no longer met inclusion criteria based on the result of rebiopsy. The extent of initial biopsy was categorized as adequate (≥ 10 cores) or inadequate (<10 cores). The association between initial biopsy extent and results of rebiopsy was tested using Fisher′s exact test. RESULTS For the 297 rebiopsied within 6 months, the median time to rebiopsy was 3.5 months. The median age at biopsy was 62 years (IQR 58, 67), with a median PSA at diagnosis of 4.3 ng/ml. No evidence of cancer was found on the repeat biopsy for 97 (33%) patients. Of the 200 (67%) men with cancer on repeat biopsy, 64 (32%) had a Gleason score 7 or more, 55 (28%) patients had more than 3 positive cores, and 28 (14%) had more than 50% of a core involved by tumor. A total of 90 (30%) patients were upstaged or upgraded. There was no significant difference in upstaging or upgrading between those with an adequate or inadequate initial biopsy (30.6% versus 29.3%; Risk difference -1.3%; 95% CI -13.3%, 10.7%; p=0.9). CONCLUSIONS Approximately one third of patients with low risk prostate cancer and candidates for active surveillance will be upstaged or upgraded after a repeated biopsy within 6 months of the initial biopsy. The rate of upgrading and upstaging does not appear to be different irrespective of first biopsy extent. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e57 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information David S. Yee More articles by this author Ari Adamy More articles by this author Rodrigo Pinochet More articles by this author Alexandra C. Maschino More articles by this author Angel M. Cronin More articles by this author Bertrand Guillonneau More articles by this author Peter T. Scardino More articles by this author James Eastham More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...