PHILADELPHIA (October 1, 2020) – Active surveillance is being increasingly used as a treatment option for men diagnosed with low-risk prostate cancer. A recent study led by researchers at Fox Chase Cancer Center, however, has found that only about 60% of men who choose active surveillance are undergoing guideline-recommended confirmatory biopsy within 12 months of their diagnosis.
“When discussing low-risk prostate cancer with patients, I sometimes use the analogy of ‘sharks’ and ‘minnows.’ The majority of early prostate cancers are ‘minnows,’ meaning their low-risk prostate cancer is unlikely to be life threatening, but some are ‘sharks,’” said author Robert G. Uzzo, MD, MBA, FACS, chair of the Department of Surgical Oncology at Fox Chase.
“Sometimes, even though the first biopsy says a patient has a low-risk ‘minnow,’ one of two things might happen. There might be a coexisting ‘shark’ that we didn’t see, or the ‘minnow’ might transform into a shark,” he added.
The National Comprehensive Cancer Network currently recommends a confirmatory prostate needle biopsy within 12 months of the initial cancer diagnosis to determine if a patient diagnosed with lower-risk prostate cancer falls into one of these two categories.
Uzzo and colleagues recently conducted the study to determine if 1,047 patients undergoing active surveillance in the Pennsylvania Urologic Regional Collaborative (PURC) were receiving guideline-directed confirmatory biopsies. PURC is a prospective collaborative of diverse urology practices in Pennsylvania and New Jersey.
“PURC was initially modeled after a larger program in the state of Michigan and has grown into the second largest urological collaborative in the country,” Uzzo said. “All academic medical centers throughout Pennsylvania and some in New Jersey as well as some large private urology groups submit data about our practices anonymously and are given feedback about how we compare to other groups. We look at the data to see what we can learn from each other and where we can improve.”
Among the men enrolled in active surveillance, 45% underwent a second biopsy at a PURC practice. Of those, 14% underwent a confirmatory biopsy within six months, and 45.7% underwent repeat biopsy from six to 12 months. In all, 60.5% of patients received confirmatory biopsy within 12 months of initial diagnosis according to the guidelines and 39% of the patients did not.
Uzzo acknowledged that guidelines are, of course, recommendations and that one hundred percent compliance is not expected.
“However, we were surprised to see that use of confirmatory biopsy was as low as it was,” he said. “When patients make the choice to enter active surveillance—and it is a good and safe choice—the tradeoff for foregoing treatment is making sure along the way that we are still making the right choice. Confirmatory biopsy within a year is the smart way to do that.”
The study, “Concordance of Confirmatory Prostate Biopsy in Active Surveillance With National Guidelines: An Analysis From the Multi-Institutional PURC Cohort,” was published in Urologic Oncology: Seminars and Original Investigations.