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Prognosis Good With Negative Biopsy in Active Surveillance

MONDAY, Nov. 30, 2020 — Men with negative biopsies during active surveillance for low-risk prostate cancer are more likely to have good long-term outcomes, according to a study published online Nov. 17 in The Journal of Urology.

Carissa E. Chu, M.D., from the University of California, San Francisco, and colleagues assessed the long-term clinical significance of consecutively negative biopsies among 514 men with low-risk prostate cancer undergoing active surveillance.

The researchers found that 22 percent of the men had one negative biopsy and 15 percent had consecutively negative biopsies. Among men with one negative biopsy and consecutively negative biopsies, the median prostate-specific antigen (PSA) density was lower versus men who never had a negative biopsy. Higher PSA density (odds ratio [OR], 1.68) and suspicious magnetic resonance imaging lesions (OR, 2.00) were associated with a higher likelihood of cancer being detected on the fourth biopsy. Furthermore, having one negative biopsy (OR, 0.22) and having consecutively negative biopsies (OR, 0.12) were associated with a lower likelihood of cancer being detected subsequently. Patients with consecutively negative biopsies (84 percent) and one negative biopsy (74 percent) had higher unadjusted 10-year treatment-free survival than those who had none (66 percent).

“For men undergoing active surveillance, negative biopsies indicate low-volume disease and lower rates of disease progression,” Chu said in a statement. “These ‘hidden’ cancers have excellent long-term outcomes and remain ideal for continued active surveillance.”

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