Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer

Ari Adamy, David S. Yee, Kazuhito Matsushita, Alexandra Maschino, Angel Cronin, Andrew Vickers, Bertrand Guillonneau, Peter T. Scardino, James A. Eastham

Research output: Contribution to journalArticlepeer-review

151 Scopus citations

Abstract

Purpose We evaluated predictors of progression after starting active surveillance, especially the role of prostate specific antigen and immediate confirmatory prostate biopsy. Materials and Methods A total of 238 men with prostate cancer met active surveillance eligibility criteria and were analyzed for progression with time. Cox proportional hazards regression was used to evaluate predictors of progression. Progression was evaluated using 2 definitions, including no longer meeting 1) full and 2) modified criteria, excluding prostate specific antigen greater than 10 ng/ml as a criterion. Results Using full criteria 61 patients progressed during followup. The 2 and 5-year progression-free probability was 80% and 60%, respectively. With prostate specific antigen included in progression criteria prostate specific antigen at confirmatory biopsy (HR 1.29, 95% CI 1.141.46, p <0.0005) and positive confirmatory biopsy (HR 1.75, 95% CI 1.013.04, p = 0.047) were independent predictors of progression. Of the 61 cases 34 failed due to increased prostate specific antigen, including only 5 with subsequent progression by biopsy criteria. When prostate specific antigen was excluded from progression criteria, only 32 cases progressed, and 2 and 5-year progression-free probability was 91% and 76%, respectively. Using modified criteria as an end point positive confirmatory biopsy was the only independent predictor of progression (HR 3.16, 95% CI 1.417.09, p = 0.005). Conclusions Active surveillance is feasible in patients with low risk prostate cancer and most patients show little evidence of progression within 5 years. There is no clear justification for treating patients in whom prostate specific antigen increases above 10 ng/ml in the absence of other indications of tumor progression. Patients considering active surveillance should undergo confirmatory biopsy to better assess the risk of progression.

Original languageEnglish (US)
Pages (from-to)477-482
Number of pages6
JournalJournal of Urology
Volume185
Issue number2
DOIs
StatePublished - Feb 2011
Externally publishedYes

Keywords

  • biopsy
  • disease progression
  • prostate
  • prostate-specific antigen
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

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