Timing of Adverse Prostate Cancer Reclassification on First Surveillance Biopsy: Results from the Canary Prostate Cancer Active Surveillance Study.
During active surveillance for localized prostate cancer, the timing of the first surveillance biopsy varies. We analyzed the Canary PASS (Prostate Cancer Active Surveillance Study) to determine biopsy timing influence on rates of prostate cancer adverse reclassification at the first active surveillance biopsy.



Of 1,085 participants in PASS, 421 had fewer than 34% of cores involved with cancer and Gleason sum 6 or less, and thereafter underwent on-study active surveillance biopsy. Reclassification was defined as an increase in Gleason sum and/or 34% or more of cores with prostate cancer. First active surveillance biopsy reclassification rates were categorized as less than 8, 8 to 13 and greater than 13 months after diagnosis. Multivariable logistic regression determined association between reclassification and first biopsy timing.



Of 421 men, 89 (21.1%) experienced reclassification at the first active surveillance biopsy. Median time from prostate cancer diagnosis to first active surveillance biopsy was 11 months (IQR 7.8-13.8). Reclassification rates at less than 8, 8 to 13 and greater than 13 months were 24%, 19% and 22% (p = 0.65). On multivariable analysis, compared to men biopsied at less than 8 months the OR of reclassification at 8 to 13 and greater than 13 months were 0.88 (95% CI 0.5,1.6) and 0.95 (95% CI 0.5,1.9), respectively. Prostate specific antigen density 0.15 or greater (referent less than 0.15, OR 1.9, 95% CI 1.1, 4.1) and body mass index 35 kg/m2or greater (referent less than 25 kg/m2, OR 2.4, 95% CI 1.1,5.7) were associated with increased odds of reclassification.



Timing of the first active surveillance biopsy was not associated with increased adverse reclassification but prostate specific antigen density and body mass index were. In low risk patients on active surveillance, it may be reasonable to perform the first active surveillance biopsy at a later time, reducing the overall cost and morbidity of active surveillance.
University of Washington School of Medicine, Seattle, Washington. Electronic address: liamcm@uw.edu.
Liam C
LC
Macleod
University of Washington School of Medicine, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington.
William J
WJ
Ellis
University of Washington School of Medicine, Seattle, Washington.
Lisa F
LF
Newcomb
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Yingye
Y
Zheng
Department of Urology, Stanford University School of Medicine, Stanford, California.
James D
JD
Brooks
University of California-San Francisco School of Medicine, San Francisco, California.
Peter R
PR
Carroll
University of British Columbia, Vancouver, British Columbia, Canada.
Martin E
ME
Gleave
Eastern Virginia Medical School, Norfolk, Virginia.
Raymond S
RS
Lance
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Peter S
PS
Nelson
University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
Ian M
IM
Thompson
Beth Deaconess Medical Center, Boston, Massachusetts.
Andrew A
AA
Wagner
University of Michigan, Ann Arbor, Michigan.
John T
JT
Wei
University of Washington School of Medicine, Seattle, Washington; Seattle Puget Sound Health Care System, Veterans Affairs Hospital, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington. Electronic address: dlin@uw.edu.
Daniel W
DW
Lin
D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000145:classification* / Q000473:pathology*; D013997:Time Factors; D057832:Watchful Waiting / Q000379:methods*
biopsy; body mass index; prostate specific antigen; prostatic neoplasms; watchful waiting