Publications

Abstract

PURPOSE: * In AS for low risk PCa, we assessed whether saturation or transperineal biopsy altered medium-term oncologic outcomes compared with standard transrectal biopsy. MATERIALS AND METHODS: * Retrospective analysis of prospectively collected data from two cohorts with localised PCa (1998-2012) undergoing AS. * PCa-specific, metastasis-free and treatment-free survival, unfavourable disease and significant cancer at RP were compared for standard (6-12 core, median 10) versus saturation (>12 core, median 16), and transrectal versus transperineal biopsy, using multivariate analysis. RESULTS: * 650 men analysed; Median (mean) follow-up of 55 (67) months. * PCa-specific, metastasis-free and BCR-free survival were 100%, 100% and 99% respectively. Radical treatment-free survival at 5 and 10 years were 57% and 45% respectively (median time to treatment 7.5 years). * On KM analysis, saturation biopsy was associated with increased objective biopsy progression requiring treatment (Log Rank x2 =5.87, p=0.01). On multivariate PH analysis, saturation biopsy (HR=1.68, p<0.01) but not transperineal approach (p=0.89) was associated with increased objective biopsy progression requiring treatment. * On logistic regression analysis of 179 men who underwent RP for objective progression, transperineal biopsy was associated with lower likelihood of unfavourable RP pathology (OR=0.42, p=0.03) but saturation biopsy did not alter the likelihood (p=0.25). * Neither transperineal or saturation biopsy altered the likelihood of significant versus insignificant cancer at RP (p=0.19 and p=0.41 respectively). CONCLUSIONS: * Active surveillance achieved satisfactory oncologic outcomes. * Saturation biopsy increased progression to treatment on AS; longer follow-up is needed to determine if this represents beneficial earlier detection of significant disease or over-treatment. * Transperineal biopsy reduced the likelihood of unfavourable disease at RP, possibly due to earlier detection of anterior tumours.