Few validated clinical tools currently exist to standardize the frequency of biopsies for men on active surveillance (AS) for low-risk prostate cancer. We sought to determine predictors of biopsy reclassification at specific time points after enrollment on AS.
We identified men with clinically low-risk prostate cancer prospectively enrolled on AS at the University of California, San Francisco between 2000-2016. Biopsy reclassification was defined as Gleason grade group (GG) ≥2 on subsequent biopsy. Multivariable Cox proportional hazards regression models were used to identify factors associated with risk of biopsy reclassification at first surveillance biopsy, 1-3, 3-5 and 5-10 years after enrollment, adjusting for clinicodemographic factors, Prostate Imaging Reporting & Data System (PI-RADS) score and genomic testing.
In total 1,031 men were included. On multivariable analysis, biopsy reclassification was associated with PSA density (PSAD) ≥0.15 (HR 3.37, 95% CI 1.83-6.21), percentage biopsy cores positive (HR 1.27, 95% 1.05-1.54), and high genomic score (HR 2.81, 95% CI 1.21-6.52) at first surveillance biopsy and also at 1-3 years, after adjustment. PSAD ≥0.15 (HR 2.36, 95% CI 1.56-3.56) and PSA kinetics (PSAk) (HR 2.19, 95% CI 1.43-3.34) were associated with reclassification at 3-5 years. A PI-RADS 4-5 score was not associated with biopsy reclassification at any time point.
High genomic score, PSAk and PSAD ≥0.15 were associated with reclassification within 3 years of commencing AS and PSAk and PSAD ≥0.15 remained associated with reclassification at 5 years after diagnosis.
The Journal of urology. 2020 Jun 10 [Epub ahead of print]
Peter E Lonergan, Samuel L Washington, Janet E Cowan, Shoujun Zhao, Hao G Nguyen, Katsuto Shinohara, Matthew R Cooperberg, Peter R Carroll
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.