Compared to annual biopsies, biennial biopsies starting after a first confirmatory biopsy were associated with short delays in detecting upgrading of about 3 to 5 months, depending on the cohort; that finding suggests the biennial practice is “justified,” according to the authors, particularly given the invasiveness and potential morbidity of annual biopsies.
The four active surveillance studies, conducted between 1995 and 2014, were conducted by Johns Hopkins University, Baltimore; Canary Prostate Active Surveillance Study (PASS); the University of California, San Francisco; and the University of Toronto.
Looking at data from different active surveillance cohorts provided a chance to look at the impact of active surveillance protocol on detection of disease progression, according to Dr. Etzioni.
Despite the “robust” consistency among cohorts in expected delays to detection of upgraded cancer, the authors noted that the risk for cancer upgrading was not generalizable among cohorts even after controlling for potentially confounding factors.
"What it really tells us, ultimately, is that even when we try to put them on the level playing field, there are still differences,” Dr. Etzioni said.
That lack of consistency suggests ongoing “practical challenges” that will have to be addressed going forward, Dr. Etzioni and her colleagues said in the article.
Although the present findings do seem to confirm biennial biopsies are a reasonable alternative to annual biopsies, Dr. Etzioni suggested that in clinical practice, biopsy frequency might need to take into account patient preference.
“A lot of men do opt out, and we need to better understand that,” she said. “We need to better understand preferences and how they change over time. My feeling is that maybe we should be thinking more in terms of ‘inactive surveillance,’ particularly in older men who have other health conditions, because I think that there's also an element of anxiety associated with biopsy.”
Funding for the study came from the National Cancer Institute.
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