Utility of Anterior Zone Biopsy in Men Enrolled in Active Surveillance for Prostate Cancer

Allison S. Glass, Neil B. Pugashetti, Marc Dall'Era, Christopher P Evans, Stanley Yap

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Anterior zone (AZ) disease is present in one-fifth of men with newly diagnosed prostate cancer and has been associated with poor pathologic features. However, anterior targeted biopsies are not a routine part of active surveillance (AS) protocols. Our purpose is to assess the utility of AZ sampling for prostate biopsy in patients undergoing surveillance for low-risk prostate cancer. Methods: A prospective data collection of men enrolled in AS between 2006 and 2014 was performed. Patient and disease characteristics were collected, including number of positive cores and Gleason score on all diagnostic and surveillance biopsies. Progression was defined as incident Gleason > 6 in any core and/or receipt of definitive therapy including radical prostatectomy or radiotherapy. Rate of anterior disease and relationship to subsequent disease progression was assessed. Results: A total of 85 men were included, of which 45% demonstrated progression. Median follow-up was 40 months. Among those undergoing AZ sampling at initial diagnosis, 37% presented with AZ disease. A total of 47% of men with AZ-only disease progressed, whereas 78% of men with AZ and peripheral zone disease progressed. This compares with a 39% rate of progression among men with only peripheral zone disease. Multivariable logistic regression identified increasing body mass index as a significant predictor of disease progression (odds ratio, 5.18; 95% confidence interval, 1.06-25.31; P = .04). Conclusions: Over one-third of men enrolled in AS for low-risk prostate cancer had AZ disease on diagnostic biopsy. Progression occurred in the majority of these men. AZ sampling should be considered in biopsy surveillance strategies.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
StateAccepted/In press - 2017

Fingerprint

Prostatic Neoplasms
Biopsy
Disease Progression
Neoplasm Grading
Prostatectomy
Prostate
Body Mass Index
Radiotherapy
Logistic Models
Odds Ratio
Confidence Intervals

Keywords

  • Detection
  • Diagnosis
  • Low risk
  • Progression
  • Prostate biopsy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

@article{1155752bf2674a6c8ba11ea1eb6c8d6e,
title = "Utility of Anterior Zone Biopsy in Men Enrolled in Active Surveillance for Prostate Cancer",
abstract = "Background: Anterior zone (AZ) disease is present in one-fifth of men with newly diagnosed prostate cancer and has been associated with poor pathologic features. However, anterior targeted biopsies are not a routine part of active surveillance (AS) protocols. Our purpose is to assess the utility of AZ sampling for prostate biopsy in patients undergoing surveillance for low-risk prostate cancer. Methods: A prospective data collection of men enrolled in AS between 2006 and 2014 was performed. Patient and disease characteristics were collected, including number of positive cores and Gleason score on all diagnostic and surveillance biopsies. Progression was defined as incident Gleason > 6 in any core and/or receipt of definitive therapy including radical prostatectomy or radiotherapy. Rate of anterior disease and relationship to subsequent disease progression was assessed. Results: A total of 85 men were included, of which 45{\%} demonstrated progression. Median follow-up was 40 months. Among those undergoing AZ sampling at initial diagnosis, 37{\%} presented with AZ disease. A total of 47{\%} of men with AZ-only disease progressed, whereas 78{\%} of men with AZ and peripheral zone disease progressed. This compares with a 39{\%} rate of progression among men with only peripheral zone disease. Multivariable logistic regression identified increasing body mass index as a significant predictor of disease progression (odds ratio, 5.18; 95{\%} confidence interval, 1.06-25.31; P = .04). Conclusions: Over one-third of men enrolled in AS for low-risk prostate cancer had AZ disease on diagnostic biopsy. Progression occurred in the majority of these men. AZ sampling should be considered in biopsy surveillance strategies.",
keywords = "Detection, Diagnosis, Low risk, Progression, Prostate biopsy",
author = "Glass, {Allison S.} and Pugashetti, {Neil B.} and Marc Dall'Era and Evans, {Christopher P} and Stanley Yap",
year = "2017",
doi = "10.1016/j.clgc.2017.07.007",
language = "English (US)",
journal = "Clinical Genitourinary Cancer",
issn = "1558-7673",
publisher = "Elsevier",

}

TY - JOUR

T1 - Utility of Anterior Zone Biopsy in Men Enrolled in Active Surveillance for Prostate Cancer

AU - Glass, Allison S.

AU - Pugashetti, Neil B.

AU - Dall'Era, Marc

AU - Evans, Christopher P

AU - Yap, Stanley

PY - 2017

Y1 - 2017

N2 - Background: Anterior zone (AZ) disease is present in one-fifth of men with newly diagnosed prostate cancer and has been associated with poor pathologic features. However, anterior targeted biopsies are not a routine part of active surveillance (AS) protocols. Our purpose is to assess the utility of AZ sampling for prostate biopsy in patients undergoing surveillance for low-risk prostate cancer. Methods: A prospective data collection of men enrolled in AS between 2006 and 2014 was performed. Patient and disease characteristics were collected, including number of positive cores and Gleason score on all diagnostic and surveillance biopsies. Progression was defined as incident Gleason > 6 in any core and/or receipt of definitive therapy including radical prostatectomy or radiotherapy. Rate of anterior disease and relationship to subsequent disease progression was assessed. Results: A total of 85 men were included, of which 45% demonstrated progression. Median follow-up was 40 months. Among those undergoing AZ sampling at initial diagnosis, 37% presented with AZ disease. A total of 47% of men with AZ-only disease progressed, whereas 78% of men with AZ and peripheral zone disease progressed. This compares with a 39% rate of progression among men with only peripheral zone disease. Multivariable logistic regression identified increasing body mass index as a significant predictor of disease progression (odds ratio, 5.18; 95% confidence interval, 1.06-25.31; P = .04). Conclusions: Over one-third of men enrolled in AS for low-risk prostate cancer had AZ disease on diagnostic biopsy. Progression occurred in the majority of these men. AZ sampling should be considered in biopsy surveillance strategies.

AB - Background: Anterior zone (AZ) disease is present in one-fifth of men with newly diagnosed prostate cancer and has been associated with poor pathologic features. However, anterior targeted biopsies are not a routine part of active surveillance (AS) protocols. Our purpose is to assess the utility of AZ sampling for prostate biopsy in patients undergoing surveillance for low-risk prostate cancer. Methods: A prospective data collection of men enrolled in AS between 2006 and 2014 was performed. Patient and disease characteristics were collected, including number of positive cores and Gleason score on all diagnostic and surveillance biopsies. Progression was defined as incident Gleason > 6 in any core and/or receipt of definitive therapy including radical prostatectomy or radiotherapy. Rate of anterior disease and relationship to subsequent disease progression was assessed. Results: A total of 85 men were included, of which 45% demonstrated progression. Median follow-up was 40 months. Among those undergoing AZ sampling at initial diagnosis, 37% presented with AZ disease. A total of 47% of men with AZ-only disease progressed, whereas 78% of men with AZ and peripheral zone disease progressed. This compares with a 39% rate of progression among men with only peripheral zone disease. Multivariable logistic regression identified increasing body mass index as a significant predictor of disease progression (odds ratio, 5.18; 95% confidence interval, 1.06-25.31; P = .04). Conclusions: Over one-third of men enrolled in AS for low-risk prostate cancer had AZ disease on diagnostic biopsy. Progression occurred in the majority of these men. AZ sampling should be considered in biopsy surveillance strategies.

KW - Detection

KW - Diagnosis

KW - Low risk

KW - Progression

KW - Prostate biopsy

UR - http://www.scopus.com/inward/record.url?scp=85026838539&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026838539&partnerID=8YFLogxK

U2 - 10.1016/j.clgc.2017.07.007

DO - 10.1016/j.clgc.2017.07.007

M3 - Article

AN - SCOPUS:85026838539

JO - Clinical Genitourinary Cancer

JF - Clinical Genitourinary Cancer

SN - 1558-7673

ER -