Additional testing may rule out active surveillance
New research suggests that men with early prostate cancer who choose active surveillance and subsequently require treatment a year later should not have been started on active surveillance in the first place; these patients may instead benefit from additional biopsy testing prior to deciding on a treatment.
“In about one-third of men who enter active surveillance, a second biopsy performed one year later shows that they are no longer candidates for active surveillance, as the cancer has become more aggressive or extensive.” says Dr Sven Wenske, a urologist at NewYork-Presbyterian/Columbia.
In a retrospective study, researchers reviewed 60 patients from NewYork-Presbyterian Hospital who were candidates for active surveillance due to a low-grade prostate cancer diagnosis. At an average of 2 months after the initial biopsy, a repeat biopsy with an average of 17 cores was performed on all the men. Results of the repeat biopsy revealed a prostate cancer grade that made one-third of the men ineligible for active surveillance.
“Interestingly, the proportion, one-third, of patients who are thought to show progression of their disease upon biopsy after 1 year of active surveillance is the same as the proportion of men in this study sample who showed features on their immediate rebiopsy…that no longer made active surveillance a viable option,” said Dr Mitchell Benson, the George F. Cahill Professor of Urology and chair of the Department of Urology at Columbia University Medical Center.
Therefore, after the initial diagnosis, researchers recommend an immediate repeat biopsy (with an increased number of tissue samples) in order to effectively identify which men are more apt to fail on active surveillance.
The study was published in the November 2012 issue of the journal Urology.
Source: NewYork-Presbyterian Hospital.