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Timing of Confirmatory Biopsies Influences Eligibility for Active Surveillance
Jessica Armstrong, BS1, Peter Haddock, PhD2, Scott V. Wiener, MD1, Ilene Staff, PhD2, Joseph Cusano, BS2, Joseph R. Wagner, MD2.
1University of Connecticut, Farmington, CT, USA, 2Hartford Hospital, Hartford, CT, USA.

Timing of Confirmatory Biopsies Influences Eligibility for Active Surveillance
BACKGROUND: While serial biopsies are a key component of most active surveillance (AS) programs, surveillance protocols differ as to when the first surveillance biopsy should be performed. Some protocols mandate a confirmatory biopsy while in others, the first surveillance biopsy is performed at 1 year. In the present study we sought to determine differential impact of obtaining the first surveillance biopsy either within 6 months or at 9-15 months after diagnosis.
METHODS: We retrospectively identified patients who enrolled in a prostate cancer active surveillance (AS) program during 2004-2015 and underwent a biopsy either between ≤1-6 months or 9-15 months after their initial diagnostic biopsy. Eligibility for enrollment in AS was defined according to MSK criteria (biopsy Gleason: ≤6; biopsy T stage: cT1c or cT2a, diagnostic PSA 12, then number of positive cores ≤25% of the total cores). We compared MSK-defined eligibility for AS in patients who received a second biopsy at either ≤1-6 or 9-15 months after their initial diagnostic biopsy.
RESULTS: 62 (53.9) and 53 (46.1%) of patients underwent a second biopsy at ≤1-6 or 9-15 months after their initial diagnostic biopsy, respectively (table). Delaying re-biopsy to 9-15 months was associated with a significant reduction in AS eligibility defined by MSK criteria (69.4 vs. 47.2%; p=0.022). Patients originally AS eligible rebiopsied at 9-15 months were more apt to be reclassified as ineligible than patients rebiopsied at ≤1-6 months (42.9 v. 25.0%, p=0.082).
CONCLUSIONS: Surveillance protocols differ as to when the first surveillance biopsy is performed. 25% of AS patients are deemed ineligible on confirmatory biopsy at ≤1-6 months. Waiting until 9-15 months resulted in 42.9% of patients becoming ineligible. These data may be helpful in patient counseling prior to AS enrollment.
Eligibility for Active Surveillance on Rebiopsy
Time between biopsy #1 and biopsy #2Time between biopsy #1 and biopsy #2
1-6 months9-15 monthsp
Number of patients (n; %)62 (53.9)53 (46.1)-
Age (years) (mean ± SD)61.9±6.062.9±6.10.354
Biopsy #1Total cores (median; IQR)12 (12-12)12 (11-12)0.644
Number of positive cores (median; IQR)1 (1-2)2 (1-2)0.159
PSA (ng/ml) (median; IQR)4.9 (4.0-6.0)4.9 (3.5-6.5)0.680
D’Amico Risk (n;%)Low61 (98.4)46 (86.8)0.023
Intermediate1 (1.6)7 (13.2)
MSK criteria for AS (n;%)Does not meet criteria6 (9.7)11 (20.8)0.117
Meet criteria56 (90.3)42 (79.2)
Biopsy #2Total cores (median; IQR)15 (12-16)12 (12-12)<0.001
Number of positive cores (median; IQR)2 (1-3)2 (1-4)0.041
PSA (ng/ml ) (median; IQR)4.9 (3.8-5.8)5.1 (3.3-7.4)0.452
D’Amico risk (n;%)No cancer13 (21.0)9 (17.0)0.205
Low34 (54.8)23 (43.4)
Intermediate or high15 (24.2)21 (39.6)
MSK criteria for AS (n;%)Does not meet criteria19 (30.6)28 (52.8)0.022
Meet criteria43 (69.4)25 (47.2)
Change from Biopsy #1 to Biopsy #2MSK-defined eligibility for AS (n;%)Patients who did not originally meet MSK criteria for ASBecame eligible for AS1 (16.7)1 (9.1)1.0
No change - remained ineligible for AS5 (83.3)10 (90.9)
Patients who originally met MSK criteria for ASNo change - remain eligible for AS42 (75.0)24 (57.1)0.082
Became ineligible for AS14 (25.0)18 (42.9)


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