The role of biopsy core number in selecting prostate cancer patients for active surveillance.
BACKGROUND
Studies offer wide variations in inclusion criteria for active surveillance (AS) in prostate cancer (PCa), but the role of the biopsy core number has not been thoroughly assessed.


OBJECTIVE
To evaluate the impact of the biopsy core number on the risk of misclassification for AS eligibility.


METHODS
This prospective study included 411 men eligible for AS who fulfilled at least one of four of the criteria reported in the literature groupings among a screening cohort of 2917 patients.


METHODS
All patients underwent a 21-core biopsy with cores mapped by location and acted as controls of themselves for the analysis of biopsy core number (6-, 12- and 21-core schemes). Radical prostatectomy (RP) was performed in 297 men (72%).


METHODS
The number of included patients, PCa extent on biopsy, rate of unfavorable disease in RP specimens, and biochemical recurrence-free survival were compared as a function of (1) the different criteria groupings for AS and (2) the biopsy core number (6, 12, or 21).


CONCLUSIONS
Of the 1104 patients with PCa, the proportion eligible for AS ranged from 22.5% to 35.4% based on AS criteria. In men who fulfilled AS criteria only in a 12-core strategy, tumor length and percentage of cancer involvement on biopsy were significantly greater than in those who fulfilled AS criteria in a 21-core scheme. The rate of unfavorable disease on RP specimens was also higher in the former group, from 28.6% to 35.9% relative to AS criteria (p=0.014, 0.044, and 0.113 in groups 2, 3, and 4, respectively).


CONCLUSIONS
Men eligible for AS based on a 21-core strategy have cancers with a lower extent of disease on biopsies and a lower risk of unfavorable disease on RP specimens regardless of how AS criteria are defined, compared with men eligible in a 12-core scheme.
Ploussard
Guillaume
G
INSERM U955 Eq07 Department of Urology, APHP, CHU Henri Mondor, Créteil, France.
Xylinas
Evanguelos
E
Salomon
Laurent
L
Allory
Yves
Y
Vordos
Dimitri
D
Hoznek
Andras
A
Abbou
Claude-Clément
CC
de la Taille
Alexandre
A
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018579:Patient Selection; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D012307:Risk Factors