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Clinical Research

Diagnostic prostate biopsy performed in a non-academic center increases the risk of re-classification at confirmatory biopsy for men considering active surveillance for prostate cancer

Prostate Cancer and Prostatic Diseases volume 18, pages 69–74 (2015)Cite this article

Subjects

Abstract

Background:

To examine whether diagnostic biopsy (B1), for patients on active surveillance (AS) for prostate cancer, performed at an outside referral centre (external) compared with our in-house tertiary center (internal), increased the risk of re-classification on the second (confirmatory) biopsy (B2).

Methods:

Patients on AS were identified from our tertiary center database (1997–2012) with PSA<10, Gleason sum (GS) ⩽6, clinical stage ⩽cT2, ⩽3 positive cores, <50% of single core involved, age ⩽75 years and having a B2. Patients who had <10 cores at B1 and delay in B2 >24 mo were excluded. Depending on center where B1 was performed, men were dichotomized to internal or external groups. All B2 were performed internally. Multivariate logistic regression examined if external B1 was a predictor of re-classification at B2.

Results:

A total of 375 patients were divided into external (n=71, 18.9%) and internal groups (n=304, 81.1%). At B2, more men in the external group re-classified (26.8%) compared with the internal group (13.8%)(P=0.008). On multivariate analysis, external B1 predicted grade-related re-classification (odds ratio (OR) 4.14, confidence interval (CI) 2.01–8.54, P<0.001) and volume-related re-classification (OR 3.43, CI 1.87–6.25, P<0.001). Other significant predictors for grade-related re-classification were age (OR 2.13 per decade, CI 1.32–3.57, P<0.001), PSA density (OR 2.56 per unit, CI 1.44–4.73, P<0.001), maximum % core involvement (OR 1.04 per percentage point, CI 1.01–1.09, P=0.02) and time between B1 and B2 (OR 1.43 per 6 months, CI 1.21–1.71, P<0.001).

Conclusion:

At our institution, patients on AS who had their initial B1 performed externally were more likely to have adverse pathological features and re-classify on internal B2.

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Authors and Affiliations

  1. Division of Urologic Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada

    L-M Wong, S Ferrara, G Trottier, G Kulkarni, R Hamilton, A Zlotta, N Fleshner & A Finelli

  2. Department of Urology and Surgery, University of Melbourne, St Vincent’s Hospital, Melbourne, Melbourne, Victoria, Australia

    L-M Wong & N Timilshina

  3. Department of Medicine, University Health Network, Toronto, Canada

    S M H Alibhai & N Timilshina

  4. Department of Pathology, University Health Network, Toronto, Canada

    A Evans, T Van der Kwast & A Toi

  5. Department of Radiology, University Health Network, Toronto, Canada

    A Toi

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  1. L-M Wong
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  2. S Ferrara
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  3. S M H Alibhai
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  4. A Evans
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  5. T Van der Kwast
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  6. G Trottier
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  7. N Timilshina
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  8. A Toi
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  9. G Kulkarni
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  10. R Hamilton
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  11. A Zlotta
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  12. N Fleshner
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  13. A Finelli
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Corresponding author

Correspondence to L-M Wong.

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Wong, LM., Ferrara, S., Alibhai, S. et al. Diagnostic prostate biopsy performed in a non-academic center increases the risk of re-classification at confirmatory biopsy for men considering active surveillance for prostate cancer. Prostate Cancer Prostatic Dis 18, 69–74 (2015). https://doi.org/10.1038/pcan.2014.48

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  • DOI: https://doi.org/10.1038/pcan.2014.48

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