TY  - JOUR
Y1  - 2019/02//
TI  - Low-risk prostate cancer selected for active surveillance with negative MRI at entry: can repeat biopsies at 1 year be avoided? A pilot study
AV  - public
N2  - Purpose: In patients considered for active surveillance (AS), the use of MRI and targeted biopsies (TB) at entry challenges the approach of routine ?per protocol? repeat systematic biopsies (SB) at 1 year. This pilot study aimed to assess whether an approach of performing repeat biopsies only if PSA kinetics are abnormal would be safe and sufficient to detect progression. /

Methods: Prospective single-centre study of 149 patients on AS with low-risk PCa, a negative MRI at entry, followed for a minimum of 12 months between 01/2007 and 12/2015. Group 1 (n?=?78) patients had per-protocol 12-month repeat SB; group 2 (n?=?71) patients did not. Surveillance tests for tumour progression were for both groups: for cause SB and MRI-TB biopsies if PSA velocity (PSA-V)?>?0.75 ng/ml/year, or PSA doubling time (PSADT)?<?3 years. The main objectives are to compare the 2-year rates of tumour progression and AS discontinuation between groups. The secondary objectives are to estimate the diagnostic power of PSA-V and PSA-DT, to predict the risk of tumour progression. /

Results: Overall, 21 out of 149 patients (14.1%) showed tumour progression, 17.1% for group 1 and 12.3% for group 2, and 31 (21.2%) discontinued AS at 2 years. There was no difference between the 2 groups (p?=?0.56). The area under the PSA-V and PSADT curves to predict tumour progression was 0.92 and 0.83, respectively. /

Conclusions: We did not find any significant difference for progression and AS discontinuation rate between the 2 groups. The PSA kinetic seems accurate as a marker of tumour progression. These results support the conduct of a multi-centre prospective trial to confirm these findings.
UR  - https://doi.org/10.1007/s00345-018-2420-6
EP  - 259
ID  - discovery10120112
VL  - 37
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
SP  - 253
PB  - SPRINGER
JF  - World Journal of Urology
A1  - Olivier, J
A1  - Kasivisvanathan, V
A1  - Drumez, E
A1  - Fantoni, J-C
A1  - Leroy, X
A1  - Puech, P
A1  - Villers, A
KW  - Prostate cancer
KW  -  Active surveillance
KW  -  MRI
KW  -  Repeat biopsy
KW  -  PSA kinetics
ER  -