Detrimental biopsies throughout energetic surveillance for prostate most cancers are related to long-term outcomes
Can early prostate cancer “go away” during follow-up? More likely, the cancer is just “hidden” – either way, negative biopsies while actively monitoring for prostate cancer are linked to excellent long-term results, a study in the Journal of Urology® reports.
It is an official gazette of the American Urological Association (AUA). The magazine is published by Wolters Kluwer in the Lippincott portfolio.
In men under active surveillance, negative biopsies indicate low disease volume and a lower rate of disease progression. These ‘hidden’ cancers have excellent long-term results and remain ideal for continued active monitoring. “
Carissa E. Chu, MD, Principal Investigator, University of California
Long term “excellent” results with negative biopsies with active monitoring
`During active surveillance, prostate cancer is carefully monitored for signs of progression through regular PSA (prostate specific antigen) screening, prostate exams, imaging, and repeated biopsies. The goal is for men to avoid or delay treatment-related side effects without affecting long-term outcomes such as cancer progression or survival.
Sometimes men who are under active surveillance have negative biopsies that show no evidence of prostate cancer. While these patients believe their cancer “disappeared”, they most likely have low volume or limited areas of prostate cancer that were not detected in the biopsy sample.
Dr. Chu comments, “While a negative biopsy is good news, the long-term effects of such ‘hidden’ cancers remains unclear.”
To assess the long-term significance of negative biopsies, the researchers analyzed 514 men who were actively monitored for early-stage prostate cancer between 2000 and 2019 at UCSF. All patients had at least three surveillance biopsies (four biopsies total) after their initial prostate cancer diagnosis. The median follow-up was almost ten years.
37 percent of patients had at least one negative biopsy during active monitoring, of which 15 percent had consecutive negative biopsies.
Men with negative surveillance biopsies had more favorable clinical characteristics, including low PSA density and fewer specimens that showed cancer on the initial prostate biopsy.
Negative biopsies were also associated with good long-term results. After 10 years, the survival rate without the need for prostate cancer treatment (such as surgery or radiation) was 84 percent for men with consecutive negative biopsies, 74 percent for men with a negative biopsy, and 66 percent for men without a negative biopsy.
Adjusting for other factors, men with one or more negative biopsies were much less likely to find cancer in a later biopsy.
However, negative biopsies didn’t mean the cancer was “gone” – even some men with consecutive negative biopsies later had positive biopsies or were diagnosed with a higher stage of cancer.
Therefore, surveillance, although less intense, is still recommended rather than “waiting vigilantly” for men in good health. Higher PSA densities and suspicious findings on prostate magnetic resonance imaging (MRI) scans were associated with a higher risk of cancer, which was found in later biopsies.
“Negative surveillance biopsies in men under active surveillance indicate prostate cancer with low volume and very favorable results,” conclude Dr. Chu and colleagues.
“In these patients, after discussing the risks and benefits, a less intensive monitoring regimen should be encouraged, particularly in those with low PSA densities and adequate MRI-targeted sampling.”
Chu, CE, et al. (2020) The Clinical Importance of Multiple Negative Surveillance Prostate Biopsies for Men with Active Surveillance – Is Cancer Going Away or Is It Just Hiding? The journal of urology. doi.org/10.1097/JU.0000000000001339.