Role of early repeat biopsies in Risk Stratified Surveillance for Prostate Cancer in the MRI era.

What is it about?

The article discusses the importance of optimal disease characterisation in Active Surveillance (AS) for patients diagnosed with early prostate cancer and embarking on a risk stratified surveillance programme (STRATCANS). In particular the role of confirmatory/early re-biopsy even though diagnostic biopsies had been informed by MRI imaging. The study analyzed data from 40 men who agreed to confirmatory re-biopsy within 12 months of diagnosis and found that 37.5% of the cohort had a GG upgrade and CPG reclassification after the re-biopsy. The study suggests that a significant proportion of men had a disease burden that was underrepresented by the initial diagnostic biopsy despite MRI guidance, and that confirmatory re-biopsy can help improve disease characterisation and allocation to the correct STRATCANS tier. Importantly we could not identify any specific risk factors for this reclassification but we acknowledge our sample size is small and likely underpowered to do this.

Featured Image

Photo by Europeana on Unsplash

Photo by Europeana on Unsplash

Why is it important?

The research is important because it evaluates the value of confirmatory re-biopsy in the Stratified Cancer Active Surveillance (STRATCANS) program for patients with early-stage prostate cancer. The study shows that a significant proportion of patients (37.5%) had a Gleason grade upgrade and clinical prognostic group (CPG) reclassification after confirmatory re-biopsy, which can impact how stringent their AS follow-up should be (which STRATCANS tier). In a few case even make them ineligible for surveillance (e.g. reclassified to CPG3 or higher). Accurate knowledge of disease burden at the outset of active surveillance is crucial to minimise both over and under-monitoring on AS, ensure we don't miss aggressive disease and better personalise patient care. Key Takeaways: 1. A significant proportion (37.5%) of patients in the STRATCANS program had Gleason grade upgrade and clinical prognostic group reclassification after confirmatory re-biopsy. 2. Most reclassifications moved men from CPG1 to CPG2, which would change how their follow-up is allocated in STRATCANS. In some cases men may not be eligible for AS anymore (e.g. and some men may decide to instead , opt for treatment. 3. The study highlights the importance of accurate knowledge of disease burden at the outset of active surveillance so AS can be managed more accurately.

Perspectives