title: Outcomes of Active Surveillance after Initial Surveillance Prostate Biopsy.
abstract: We analyzed the rates of disease reclassification at initial and subsequent surveillance prostate biopsy as well as the treatment outcomes of deferred therapy among men on active surveillance for prostate cancer.
  
  
  
  From a prospective database we identified 300 men on active surveillance who had undergone initial surveillance prostate biopsy, with or without confirmatory biopsy, within 1 year of diagnosis. Of these men 261 (87%) were classified as having NCCN very low or low risk disease at diagnosis. Disease reclassification on active surveillance was defined as the presence of 50% or more positive cores and/or surveillance prostate biopsy Gleason score upgrading. Patients with type I disease reclassification included those with any surveillance prostate biopsy Gleason score upgrading, while patients with type II reclassification had to have primary Gleason pattern 4-5 disease on surveillance prostate biopsy. Outcomes after initial surveillance prostate biopsy were evaluated using actuarial analyses.
  
  
  
  At the time of initial surveillance prostate biopsy 49 (16%) and 19 (6%) patients had type I and type II disease reclassification, respectively. Those who underwent confirmatory biopsy had significantly reduced rates of type I (9% vs 23%, p=0.001) and type II (3% vs 9%, p=0.01) reclassification at initial surveillance prostate biopsy. For the 251 patients without disease reclassification at initial surveillance prostate biopsy the 2-year rates of subsequent type I and II reclassification were 17% (95% CI 0-24) and 3% (95% CI 0.1-7), respectively. For the 93 patients who received deferred therapy the 5-year biochemical progression-free probability was 89% (95% CI 79-98), including 95%, 82% and 70% among those without, and those with type I and type II disease reclassification, respectively.
  
  
  
  Patients on active surveillance with stable disease at the time of initial surveillance prostate biopsy may be appropriate candidates for less intensive surveillance prostate biopsy schedules.
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: drevankovac@gmail.com.
authors.forename: Evan
authors.initials: E
authors.lastname: Kovac
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Gregory
authors.initials: G
authors.lastname: Lieser
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Urology Department, Medical School, Cairo University, Giza, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elshafei
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D001707:Biopsy, Needle; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014481:United States; D057832:Watchful Waiting / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: biopsy; disease progression; outcome assessment; prostatic neoplasms; watchful waiting