Impact of Early Confirmatory Tests on Upgrading and Conversion to Treatment in Prostate Cancer Patients on Active Surveillance

Published:September 15, 2020DOI:


      To assess the impact of confirmatory tests on active surveillance (AS) biopsy disease reclassification and progression to treatment in men with favorable risk prostate cancer (FRPC).


      We searched the MUSIC registry for men with FRPC managed with AS without or with a confirmatory test. Confirmatory tests included (1) repeat prostate biopsy, (2) genomic tests, (3) prostate magnetic resonance imaging (MRI), or (4) MRI followed by a post-MRI biopsy. Confirmatory test results were deemed reassuring (RA) or nonreassuring (nonRA) according to predefined criteria. Kaplan-Meier curves and multivariable Cox regression models were used to compare surveillance biopsy disease reclassification-free survival and treatment-free survival.


      Of the 2,514 men with FRPC who were managed on AS, 1211 (48%) men obtained a confirmatory test. We noted differences in the 12-month unadjusted surveillance biopsy disease reclassification-free probability (68%, 83%, and 90%, P < .0001) and 24-month unadjusted treatment-free probability (55%, 81%, and 79%, P < .0001), for men with nonRA confirmatory tests, no confirmatory test, and RA confirmatory tests, respectively. Excluding patients with genomic confirmatory tests, men with RA confirmatory tests were associated with a lower hazard (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.38-0.84, P = .005) and men with nonRA confirmatory tests had an increased hazard (HR 1.97, 95% CI 1.22-3.19, P = .006) of surveillance disease reclassification compared with men without confirmatory tests in the multivariable model.


      These data suggest men with RA confirmatory tests have less surveillance biopsy reclassification and remain on AS longer than men with nonRA test results. Confirmatory tests may help risk stratify men considering active surveillance.
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        • Sanda MG
        • Cadeddu JA
        • Kirkby E
        • et al.
        Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options.
        J Urol. 2017; 199: 683-690
        • Tosoian JJ
        • Mamawala M
        • Epstein JI
        • et al.
        Active surveillance of grade group 1 prostate cancer: long-term outcomes from a large prospective cohort.
        Eur Urol. 2020; 77: 675-682
        • 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
        • Mahal BA
        • Butler S
        • Franco I
        • et al.
        Use of active surveillance or watchful waiting for low-risk prostate cancer and management trends across risk groups in the United states, 2010-2015.
        JAMA. 2019; 321: 704-706
        • Auffenberg GB
        • Lane BR
        • Linsell S
        • et al.
        A roadmap for improving the management of favorable risk prostate cancer.
        J Urol. 2017; 198: 1220-1222
        • Cher ML
        • Dhir A
        • Auffenberg GB
        • et al.
        Appropriateness criteria for active surveillance of prostate cancer.
        J Urol. 2017; 197: 67-74
        • Kaye DR
        • Qi J
        • Morgan TM
        • et al.
        Association between early confirmatory testing and the adoption of active surveillance for men with favorable-risk prostate cancer.
        Urology. 2018; 118: 127-133
        • Shapiro DD
        • Ward JF
        • Lim AH
        • et al.
        Comparing confirmatory biopsy outcomes between MRI-targeted biopsy and standard systematic biopsy among men being enrolled in prostate cancer active surveillance.
        BJU Int. 2020; (epub ahead of print)
        • Lin DW
        • Zheng Y
        • McKenney JK
        • et al.
        17-Gene genomic prostate score test results in the canary prostate active surveillance study (PASS) cohort.
        J Clin Oncol. 2020; 38: 1549-1557
        • Kasivisvanathan V
        • Rannikko AS
        • Borghi M
        • et al.
        MRI-targeted or standard biopsy for prostate-cancer diagnosis.
        N Engl J Med. 2018; 378: 1767-1777
        • Kornberg Z
        • Cooperberg MR
        • Cowan JE
        • et al.
        A 17-gene genomic prostate score as a predictor of adverse pathology in men on active surveillance.
        J Urol. 2019; 202: 702-709
      1. Prolaris: Understanding the Prolaris Score.

      2. OncotypeDx: Healthcare Professionals: Oncotype Dx Genomic Prostate Score.

      3. Decipher: Providing Treatment Information for Prostate Cancer Patients.

        • Weinreb JC
        • Barentsz JO
        • Choyke PL
        • et al.
        PI-RADS prostate imaging - reporting and data system: 2015, version 2.
        Eur Urol. 2016; 69: 16-40
        • Cooperberg MR
        • Carroll PR
        • Dall'Era MA
        • et al.
        The state of the science on prostate cancer biomarkers: the San Francisco consensus statement.
        Eur Urol. 2019; 76: 268-272
        • Vince Jr., RA
        • Tosoian JJ
        • Jackson WC
        • et al.
        Tissue-based genomics: which test and when.
        Curr Opin Urol. 2019; 29: 598-604