The timing of first biopsy and its effect on prostate cancer reclassification

The authors aimed to determine the influence of biopsy timing on prostate cancer reclassification during active surveillance. 

The authors concluded that the timing of the first biopsy was not related to an increased risk of cancer reclassification, but prostate specific antigen (PSA) and body mass index (BMI – measured based on a persons weight and height) were. They also suggested that low risk patients could prolong their time until their first biopsy to avoid cost and morbidity of active surveillance. 

Active surveillance is a form of cancer management that does not involve active treatment. Instead, the cancer is monitored through a test called a biopsy, which samples tissue taken from the tumor site to detect any signs of cancer growth. This is typically used in men with low-risk cancer (confined to the prostate, small tumor size, low PSA levels). PSA is a protein that is elevated in the blood in the presence of prostate cancer and can also be used as an indicator for cancer growth. A biopsy is taken at certain points throughout active surveillance, to determine whether the cancer has spread and whether further active treatments are necessary.

The link between the timing of the first biopsy and risk of reclassification is not fully known. Further research is needed to determine whether the timing of the first biopsy is important to prevent reclassification (a change in risk category, such as tumor growth, risk, clinical stage) in men undergoing active surveillance.

The aim of this study was to determine whether the timing of biopsy had an impact on the risk of reclassification in prostate cancer. 

421 men were used in this study with a follow-up of 30 months. The average time until first biopsy was 11 months. 21.1% of men were reclassified at their first biopsy. There was no difference in the rate of reclassification, regardless of whether the first biopsy was carried out at 8 months (24%), 8-13 months (19%) or more than 13 months (22%). 34% of men had no cancer identified on their first biopsy. Men who had a PSA level of 0.15 ng or greater and a BMI of more than 35 kg/m2 (obese) were at an increased risk of undergoing cancer reclassification. 

The authors concluded that the timing of the first biopsy was not related to an increased risk of cancer reclassification, but prostate specific antigen (PSA) and body mass index (BMI – measured based on a persons weight and height) were. They also suggested that low risk patients could prolong their time until their first biopsy to avoid cost and morbidity of active surveillance.