Among men undergoing active surveillance for low-risk prostate cancer, biennial biopsies appear to be an acceptable alternative to annual biopsies, according to a retrospective review of four large surveillance cohorts.
Looking specifically at time to biopsy upgrade, “The consequences of more versus less frequent biopsies seem to be similar across cohorts,” investigators reported online in the Annals of Internal Medicine (Nov. 28, 2017).
These findings provide a “quantitative justification” for the recent American Society of Clinical Oncology practice guideline that recommends less frequent biopsies following a confirmatory biopsy within a year of starting active surveillance, said the study’s senior author, Ruth Etzioni, PhD, of Fred Hutchinson Cancer Research Center, Seattle.
“A biopsy is not a trivial matter,” Dr. Etzioni said in an interview with Urology Times. “So if [the patient] is in a low-risk situation, we can now put some numbers around what the downside of less frequent biopsies will be in terms of the delay in treatment, and they're not very bad.”
The findings underscore the fact that active surveillance is “a very low-risk setting” with a low chance of an adverse disease-related outcome over the long term, Dr. Etzioni added.
To assess the impact of less frequent biopsies, Dr. Etzioni and colleagues statistically modeled the risk for biopsy upgrading in data from four active surveillance cohorts including 2,576 patients with T1 or T2 prostate cancer and a Gleason score between 2 and 6.