Pathological Upgrading and Up Staging With Immediate Repeat Biopsy in Patients Eligible for Active Surveillance

Abstract

AS is a treatment regimen used in patients with low-risk prostate cancer. Decision making is based on pre-treatment PSA, clinical stage, and prostate biopsy results. We review our experience with immediate repeat biopsy in patients eligible for AS. A retrospective review of consecutive patients undergoing repeat biopsy within 3 months of a first positive biopsy from March 2002 until June 2007 was analyzed. Patients were considered eligible if they had a PSA < 10 ng/ml, clinical stage ≤ T2a, Gleason pattern ≤ 3, 3 or less cores positive, and no single core with ≥ 50% cancer involvement. A total of 104 patients met the eligibility criteria. Of the repeat biopsies performed, 27/104 (26%) were negative, 59/104 (57%) had Gleason score ≤ 6, 17/104 (16%) had Gleason score 7, one patient had Gleason score 9, 10/104 (10%) of patients had > 3 cores involved on repeat biopsy, and 12/104 (12%) had ≥ 50% involvement of at least one core. A total of 28/104 (27%) patients were upgraded and/or upstaged. Treated patients who were upgraded and/or upstaged were more likely to have higher pathologic stage (p = 0.003) and grade (p = 0.001) at RP than those who were not. Immediate repeat biopsy for patients on AS resulted in 27% being upgraded or upstaged, and those were more likely to have higher grade and stage disease at RP. We recommend repeat biopsy as it improved our discrimination as to whom are the best candidates for AS.