207 Background: Active surveillance (AS) is considered the standard of care for managing patients with low-risk prostate cancer. Identifying risk factors for disease progression on AS can improve risk stratification. As previously described, the presence of bilateral disease may affect disease progression. Current systematic biopsy techniques inadequately predict presence of bilateral disease. We hypothesize that combined mpMRI-guided fusion biopsy and systematic biopsy will improve detection of bilateral disease. Methods: Our institutional database of patients referred for AS from 2007-2020 was queried. All AS patients received combined 12-core systematic biopsy and mpMRI-Fusion biopsy (Cbx), and those with Gleason Grade group 1 (GG1) on confirmatory Cbx were included. Cox regression analysis identified baseline characteristics associated with AS progression, defined as progression to GG ≥ 2. The distributions of GG and National Comprehensive Cancer Network (NCCN) risk categories were also compared. Results: 103 patients with prostate cancer and at least one follow-up biopsy at our institution were included in the analysis. 30% (31/103) had bilateral disease and 70% (72/103) had unilateral disease. On univariable and multivariable analysis, both PSAD (univariable HR = 1.6; 95% CI: 1.1-2.2; multivariable HR = 1.7; CI: 1.2-2.5) and presence of bilateral disease (univariable HR = 2.2; 95% CI: 1.3-4.0; multivariable HR = 2.2; 95% CI: 1.2-4.0) at time of confirmatory biopsy were significantly associated with AS progression. On Kaplan-Meier analysis, median time from Cbx to AS progression ≥ GG2 for the whole cohort was 52 months (95% CI: 44 - 68). The median time to progression for patients with unilateral and bilateral disease was 68 months and 52 months, respectively (log-rank test, p = 0.0055). Bilateral disease was marginally associated with receiving an NCCN score of high or very high on upgraded biopsy (RR: 3.16, 95% CI: 1.004-9.932). NCCN score at time of confirmatory biopsy was not associated with progression. However, NCCNs scores and GG at time of progression were higher among patients with bilateral disease (p = 0.015 and p = 0.024). Ultimately, use of combined biopsy resulted in 16.1% more bilateral cancers detected when compared to systematic biopsy. Conclusions: Detection of bilateral disease using combined biopsy was significantly associated with disease progression in patients on AS. Notably, combined biopsy resulted in greater detection of bilateral disease than systematic biopsy alone. Identifying presence of bilateral disease using combined biopsy could ultimately contribute to management decisions in patients on AS.
Prostatic and Dietary Omega-3 Fatty Acids and Prostate Cancer Progression during Active Surveillance
