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Active Surveillance Following Modified Transperineal Template Guided Saturation Biopsy Demonstrates a Low Rate of Progression and Conversion to Radical Treatment, with Age and PSA Associated with Upgrading, Upstaging and Treatment

Debashis Sarkar, Kinsley Ekwueme and Nigel J Parr

Objectives: To evaluate outcomes in patients embarking upon active surveillance for Prostate cancer (Pca) following tumour characterisation by modified transperineal template guided saturation biopsy.
Materials and Methods: Of 500 patients with initial negative conventional transrectal ultrasound guided prostate biopsy underwent transperineal template guided saturation biopsy, detected cancer in 276 (55%). Of these, 30 (11%) elected for active surveillance. Another 158 patients considering active surveillance after initial positive transrectal ultrasound guided biopsy underwent confirmatory transperineal template guided saturation biopsy, with 43 (27%) subsequently electing for active surveillance. A total of 73 patients from these two groups (median age 63 years) were, thus, enrolled for active surveillance. Follow up consisted of 3 monthly PSA and DRE, offering repeat Multi-parametric MRI and repeat transperineal template Guided Saturation Biopsy, at 24 months, or on suspicion of progression.
Results: At a median follow up of 58 months, 59 patients have undergone repeat Multi-parametric MRI. Radiological progression was identified in 6 (8%), Gleason upgrading on repeat transperineal template guided saturation biopsy, in 14 (19%). Six (8%) have undergone radical treatments. Age >60 yrs and PSA >5 ng/mL were associated with upgrading and upstaging (p<0.05).
Conclusion: A large proportion of patients initially considering active surveillance dropped out following confirmatory transperineal template Guided saturation biopsy, however, in those electing for active surveillance after transperineal template guided saturation biopsy, progression rates are low and related to age and presenting PSA.