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The Value of an Extensive Transrectal Repeat Biopsy with Anterior Sampling in Men on Active Surveillance for Low-risk Prostate Cancer: A Comparison from the Randomised Study of Active Monitoring in Sweden (SAMS)
Univ Gothenburg, Sahlgrenska Acad, Dept Urol, SE-41345 Gothenburg, Sweden.
Sahlgrens Univ Hosp, Reg Canc Ctr, Vastra Gotaland, Gothenburg, Sweden.
Orebro Univ Hosp, Dept Urol, Orebro, Sweden.
Karolinska Inst, Dept Mol Med & Surg, Sect Urol, Stockholm, Sweden.
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2019 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 76, no 4, p. 461-466Article in journal (Refereed) Published
Abstract [en]

Background: A systematic repeat biopsy is recommended for men starting on active surveillance for prostate cancer, but the optimal number and distribution of cores are unknown. Objective: To evaluate an extensive repeat transrectal biopsy with anterior sampling in men starting on active surveillance. Design, setting, and participants: Randomised multicentre trial. From 2012 to 2016, 340 Swedish men, aged 40-75 yr, with recently diagnosed low-volume Gleason grade group 1 prostate cancer were included. Intervention: Either an extensive transrectal biopsy with anterior sampling (median 19 cores) or a standard transrectal biopsy (median 12 cores). Outcome measurements and statistical analysis: Primary outcome measure: Gleason grade group >= 2 cancer. Secondary outcomes: Cancer in anteriorly directed biopsy cores and postbiopsy infection. Nonparametric statistical tests were applied. Results and limitations: Gleason grade group >= 2 cancer was detected in 16% of 156 men who had an extensive biopsy and in 10% of 164 men who had a standard biopsy, a 5.7% difference (95% confidence interval [CI]-0.2% to 13%, p = 0.09). There was a strong linear association between prostate-specific antigen (PSA) density and cancer in the anteriorly directed biopsy cores. The odds ratios for cancer in the anteriorly directed cores were for any cancer 2.2 (95% CI 1.3-3.9, p = 0.004) and for Gleason grade group >= 2 cancer 2.3 (95% CI 1.2-4.4, p = 0.015) per 0.1-ng/ml/cm(3) increments. Postbiopsy infections were equally common in the two groups. A limitation is that magnetic resonance imaging was not used. Conclusions: The trial did not support general use of the extensive transrectal repeat biopsy template, but cancer in the anteriorly directed cores was common, particularly in men with high PSA density. The higher the PSA density, the stronger the reason to include anterior sampling at a systematic repeat biopsy. Patient summary: This trial compared two different templates for transrectal prostate biopsy in men starting on active surveillance for low-risk prostate cancer. Cancer was often found in the front part of the prostate, which is not sampled on a standard prostate biopsy. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER , 2019. Vol. 76, no 4, p. 461-466
Keywords [en]
Active surveillance, Biopsy, Prostate cancer, Randomised clinical trial
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:uu:diva-395727DOI: 10.1016/j.eururo.2019.02.035ISI: 000487930900025PubMedID: 30878303OAI: oai:DiVA.org:uu-395727DiVA, id: diva2:1365268
Funder
Swedish Cancer SocietyAvailable from: 2019-10-24 Created: 2019-10-24 Last updated: 2019-10-24Bibliographically approved

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Johansson, EvaStattin, Pär

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