PMID- 32701446
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210101
IS  - 1911-6470 (Print)
IS  - 1920-1214 (Electronic)
IS  - 1911-6470 (Linking)
VI  - 15
IP  - 1
DP  - 2021 Jan
TI  - Active surveillance before radiotherapy: Outcome and predictive factors for 
      multiple biopsies before treatment.
PG  - E36-E40
LID - 10.5489/cuaj.6523 [doi]
AB  - INTRODUCTION: We aimed to investigate whether patients on active surveillance 
      (AS) had worse outcomes than patients who received immediate treatment with 
      radiotherapy and whether a Gleason grade progression on repeat biopsy influenced 
      outcome. METHODS: From our institutional database, we identified 2001 patients 
      treated between 2005 and 2019 with primary external beam radiation therapy or 
      brachytherapy. Biochemical recurrence (BCR) was analyzed in relation to clinical 
      factors such as a Gleason grade progression or having multiple biopsies vs. only 
      one biopsy. Patients on AS were identified as those who had undergone >/=2 
      biopsies. We used log-rank tests for univariate analysis (UVA) and Cox regression 
      analysis for multivariable analysis (MVA). RESULTS: Of 2001 patients, 374 (19%) 
      patients had >/=2 biopsies before treatment, of which 48% presented with a Gleason 
      grade progression of mostly to Gleason 3+4 (36%); 32% had a cancer volume 
      increase on biopsy and 16% had no significant change on biopsy. For patients with 
      >/=2 biopsies, median time from first biopsy to treatment was 22.0 months 
      (interquartile range [IQR] 14.7-36.1). By UVA, patients with Gleason grade 
      progression (n=105) had a worse BCR-free rate (p=0.02) than patients who had no 
      grade progression on repeat biopsy or only one biopsy. On MVA, this effect was 
      lost. Having >/=2 biopsies was not a significant negative prognostic factor on UVA 
      (p=0.2) or MVA. CONCLUSIONS: In our experience, radiotherapy after a period of 
      AS, even with Gleason grade progression, did not lead to worse outcomes compared 
      to patients who had radiotherapy after only one biopsy.
FAU - Alcaidinho, Alexandre
AU  - Alcaidinho A
AD  - Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, 
      Montreal, QC, Canada.
FAU - Delouya, Guila
AU  - Delouya G
AD  - Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, 
      Montreal, QC, Canada.
FAU - Bahary, Jean-Paul
AU  - Bahary JP
AD  - Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, 
      Montreal, QC, Canada.
FAU - Saad, Fred
AU  - Saad F
AD  - Division of Urology, Centre hospitalier de l'Universite de Montreal, Montreal, 
      QC, Canada.
FAU - Taussky, Daniel
AU  - Taussky D
AD  - Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal, 
      Montreal, QC, Canada.
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - Can Urol Assoc J
JT  - Canadian Urological Association journal = Journal de l'Association des urologues 
      du Canada
JID - 101312644
PMC - PMC7769527
COIS- Competing interests: Dr. Delouya has been a consultant/advisory board member for 
      AbbVie, Astellas, AstraZeneca, Bayer, ELEKTA, Janssen, Sanofi, and TerSera. Dr. 
      Saad has been a consultant/advisory board member for AbbVie, Astellas, 
      AstraZeneca, Bayer, Janssen, and Sanofi. Dr. Taussky has received research 
      support from Sanofi. The remaining authors report no competing personal or 
      financial interests related to this work.
EDAT- 2020/07/24 06:00
MHDA- 2020/07/24 06:01
PMCR- 2021/01/01
CRDT- 2020/07/24 06:00
PHST- 2020/07/24 06:00 [pubmed]
PHST- 2020/07/24 06:01 [medline]
PHST- 2020/07/24 06:00 [entrez]
PHST- 2021/01/01 00:00 [pmc-release]
AID - cuaj.6523 [pii]
AID - cuaj-1-e36 [pii]
AID - 10.5489/cuaj.6523 [doi]
PST - ppublish
SO  - Can Urol Assoc J. 2021 Jan;15(1):E36-E40. doi: 10.5489/cuaj.6523.