title: Confirmatory biopsy for the assessment of prostate cancer in men considering active surveillance: reference centre experience.
abstract: OBJECTIVE
  To evaluate how accurate a 12-core transrectal biopsy derived low-risk prostate cancer diagnosis is for an active surveillance programme by comparing the histological outcome with that from confirmatory transperineal sector biopsy.
  
  
  METHODS
  The cohort included 166 men diagnosed with low volume Gleason score 3+3 prostate cancer on initial transrectal biopsy who also underwent a confirmatory biopsy. Both biopsy techniques were performed according to standard protocols and samples were taken for histopathology analysis. Subgroup analysis was performed according to disease severity at baseline to determine possible disease parameters of upgrading at confirmatory biopsy.
  
  
  RESULTS
  After confirmatory biopsy, 34% demonstrated Gleason score upgrade, out of which 25% were Gleason score 3+4 and 8.5% primary Gleason pattern 4. Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found.
  
  
  CONCLUSIONS
  In our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy. Furthermore 8.5% of these upgraders had a primary Gleason pattern 4. Our results together with previously published evidence highlight the need for the revision of current guidelines in prostate cancer diagnosis for the selection of men for active surveillance.
authors.affiliation: King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bosco
authors.affiliation: European Institute of Urology, Division of Urology, Milan, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cozzi
authors.affiliation: Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.
authors.forename: Janette
authors.initials: J
authors.lastname: Kinsella
authors.affiliation: Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bianchi
authors.affiliation: Southend University Hospital NHS Foundation Trust, Southend SS0 0RY, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Acher
authors.affiliation: Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Challacombe
authors.affiliation: Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.
authors.forename: Rick
authors.initials: R
authors.lastname: Popert
authors.affiliation: King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.
authors.forename: Christian
authors.initials: C
authors.lastname: Brown
authors.affiliation: King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK; Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.
authors.forename: Gincy
authors.initials: G
authors.lastname: George
authors.affiliation: King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London SE1 9RT, UK.
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
authors.affiliation: Guy's and St Thomas' Hospital NHS Foundation Trust, London SE1 9RT, UK.
authors.forename: Declan
authors.initials: D
authors.lastname: Cahill
keywords: active surveillance; confirmatory biopsy; prostate biopsy; prostate cancer; transperineal sector biopsy; transrectal biopsy