ORLANDO, FL (UroToday) - Active surveillance (AS) is an emerging treatment regimen used in patients with low-risk prostate cancer. Decision making is often based on pre-treatment PSA, clinical stage, and prostate biopsy results. Patients referred to a tertiary center often have biopsies that are heterogeneous in quantity and quality. A group from Memorial Sloan Kettering Cancer Center reports their experience with immediate repeat biopsy in patients eligible for AS.

They retrospectively reviewed consecutive patients undergoing repeat biopsy within 3 months of a first positive biopsy for the period between 2002 and 2007. Patients were considered eligible if they had a PSA < 10 ng/ml, clinical stage < T2b, Gleason grade 50% involvement of at least one core. A total of 27/104 (26%) patients were upgraded or upstaged. Sixty patients eventually underwent surgery with no biochemical recurrences at a median follow-up of 13 months, except one patient who developed metastatic disease at 46 months following surgery.

Immediate repeat biopsy in patients with prostate cancer being considered for AS resulted in more than one quarter being upgraded or upstaged, thus yielding improved discrimination as to whom is the best candidate for AS. The majority of patients in this low-risk group eventually elected radical prostatectomy.

Presented by Ryan K Berglund, MD, Timothy A Masterson, MD, Kinjal C Vora, MD, Scott E Eggener, MD, James A Eastham, MD, and Bertrand D Guillonneau, MD at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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