Association Between Early Confirmatory Testing and the Adoption of Active Surveillance for Men With Favorable-risk Prostate Cancer


      To examine the relationship between the use and results of early confirmatory testing and persistence on active surveillance (AS).


      We identified all men in the Michigan Urological Surgery Improvement Collaborative registry diagnosed with favorable-risk prostate cancer from June 2016 to June 2017. We next examined trends in the use of early confirmatory test(s), defined as repeat biopsy, prostate magnetic resonance imaging, or molecular classifiers obtained within 6 months of the initial cancer diagnosis, in patients with favorable-risk prostate cancer. We then compared the proportion of men remaining on AS 6 months after diagnosis according to reassuring vs nonreassuring results, also stratifying by age and Gleason score.


      Among 2529 patients, 32.7% underwent early confirmatory testing within 6 months of diagnosis. Its use increased from 25.4% in the second quarter of 2016 to 34.9% in the second quarter of 2017 (P = .025). Molecular classifiers were most frequently used (55%), followed by magnetic resonance imaging (34%) and repeat biopsy (11%). Sixty-four percent (n = 523) had a reassuring result. Rates of AS were higher for patients with early reassuring results; 82% remained on AS (n = 427) compared to 52% (n = 157) of those with nonreassuring results and 51% (n = 873) with no early confirmatory testing (P <.001).


      Rates of AS are higher among men with early reassuring results, supporting the clinical utility of these tests. Nonetheless, high rates of AS among patients with nonreassuring results underscore the complexity of shared decision-making in this setting.
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        • Auffenberg G.B.
        • Lane B.R.
        • Linsell S.
        • et al.
        A roadmap for improving the management of favorable risk prostate cancer.
        J Urol. 2017; 198: 1220-1222
        • Womble P.R.
        • Montie J.M.
        • Ye Z.
        • et al.
        Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer.
        Eur Urol. 2015; 67: 44-50
        • Klotz L.
        • Vesprini D.
        • Sethukavalan P.
        • et al.
        Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.
        J Clin Oncol. 2015; 33: 272-277
        • Selvadurai E.D.
        • Singhera M.
        • Thomas K.
        • et al.
        Medium-term outcomes of active surveillance for localised prostate cancer.
        Eur Urol. 2013; 64: 981-987
        • Cher M.L.
        • Dhir A.
        • Auggenberg G.B.
        • et al.
        Appropriateness criteria for active surveillance of prostate cancer.
        J Urol. 2017; 197: 67-74
        • Latifoltojar A.
        • Dikaios N.
        • Ridout A.
        • et al.
        Evolution of multi-parametric MRI quantitative parameters following transrectal ultrasound-guided biopsy of the prostate.
        Prostate Cancer Prostatic Dis. 2015; 18: 343-351
        • Prolaris
        Understanding the Prolaris score.
        (Available at:)
        • Decipher
        Providing treatment information for prostate cancer patients.
        (Available at:)
        • OncotypeDx
        Healthcare professionals: Oncotype Dx genomic prostate score.
        (Available at:)
        • Barzell W.E.
        • Melamed M.R.
        • Cathcart P.
        • et al.
        Identifying candidates for active surveillance: an evaluation of the repeat biopsy strategy for men with favorable risk prostate cancer.
        J Urol. 2012; 188: 762-767
        • Recabal P.
        • Ehdaie B.
        The role of MRI in active surveillance for men with localized prostate cancer.
        Curr Opin Urol. 2015; 25: 504-509
        • Guo R.
        • Cai L.
        • Fan Y.
        • et al.
        Magnetic resonance imaging on disease reclassification among active surveillance candidates with low-risk prostate cancer: a diagnostic meta-analysis.
        Prostate Cancer Prostatic Dis. 2015; 18: 221-228
        • Loeb S.
        • Ross A.E.
        Genomic testing for localized prostate cancer: where do we go from here?.
        Curr Opin Urol. 2017; 27: 495-499
        • Badani K.K.
        • Kemeter M.J.
        • Febbo P.G.
        • et al.
        The impact of a biopsy based 17-gene genomic prostate score on treatment recommendations in men with newly diagnosed clinically prostate cancer who are candidates for active surveillance.
        Urol Pract. 2015; 2: 181-189
        • Shore N.D.
        • Kella N.
        • Moran B.
        • et al.
        Impact of the cell cycle progression test on physician and patient treatment selection for localized prostate cancer.
        J Urol. 2016; 195: 612-618
        • Tosoian J.J.
        • Chappidi M.R.
        • Bishoff J.T.
        • et al.
        Prognostic utility of biopsy-derived cell cycle progression score in patients with National Comprehensive Cancer Network low-risk prostate cancer undergoing radical prostatectomy: implications for treatment guidance.
        BJU Int. 2017; 120: 808-814
        • Klein E.A.
        • Santiago-Jimenez M.
        • Yousefi K.
        • et al.
        Molecular analysis of low grade prostate cancer using a genomic classifier of metastatic potential.
        J Urol. 2017; 197: 122-128
        • Cuzick J.
        • Stone S.
        • Fisher G.
        • et al.
        Validation of an RNA cell cycle progression score for predicting death from prostate cancer in a conservatively managed needle biopsy cohort.
        Br J Cancer. 2015; 113: 382-389
        • Cuzick J.
        • Swanson G.P.
        • Fisher G.
        • et al.
        Prognostic value of an RNA expression signature derived from cell cycle proliferation genes in patients with prostate cancer: a retrospective study.
        Lancet Oncol. 2011; 12: 245-255
        • Klein E.A.
        • Cooperberg M.R.
        • Magi-Galluzzi C.
        • et al.
        A 17-gene assay to predict prostate cancer aggressiveness in the context of Gleason grade heterogeneity, tumor multifocality, and biopsy undersampling.
        Eur Urol. 2014; 66: 550-560