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Re: Dudith Pierre-Victor, Howard L. Parnes, Gerald L. Andriole, et al. Prostate Cancer Incidence and Mortality Following a Negative Biopsy in a Population Undergoing PSA Screening. Urology 2021 Jun 26;S0090-4295(21)00539-2

      We read with great interest the recent work of Pierre-Victor et al on prostate cancer incidence and mortality in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.
      • Pierre-Victor D
      • Parnes HL
      • Andriole GL
      • Pinsky PF
      Prostate cancer incidence and mortality following a negative biopsy in a population undergoing PSA screening.
      We previously reported, in 2017, on a similar cohort from this trial.
      • Lewicki P
      • Shoag J
      • Golombos DM
      • et al.
      Prognostic significance of a negative prostate biopsy: an analysis of subjects enrolled in a prostate cancer screening trial.
      We studied men in the screening arm who screened positive (via prostate-specific antigen or digital rectal exam) during the first year of the trial, and whose linked biopsy was negative. We found a similar mortality rate after a median follow-up of 12.9 years of 1.1% (vs 1.2% in the present study). The slightly divergent study design and the longer survival follow-up as the data has matured (median 16.6 years in Pierre-Victor et al) likely contribute to this slight difference. These results re-emphasize the favorable prognostic significance of a negative prostate biopsy in the pre-MRI era. These data remain highly relevant. They suggest that while magnetic resonance imaging and targeted biopsy may be advantageous in terms of reducing repeat biopsies, given the favorable prognosis among men with a prior negative biopsy in the pre-MRI era, the window for a mortality benefit from these technologies appears remarkably narrow.
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      References

        • Pierre-Victor D
        • Parnes HL
        • Andriole GL
        • Pinsky PF
        Prostate cancer incidence and mortality following a negative biopsy in a population undergoing PSA screening.
        Urology. 2021; (Published online June)https://doi.org/10.1016/j.urology.2021.05.060
        • Lewicki P
        • Shoag J
        • Golombos DM
        • et al.
        Prognostic significance of a negative prostate biopsy: an analysis of subjects enrolled in a prostate cancer screening trial.
        J Urol. 2017; 197: 1014-1019https://doi.org/10.1016/j.juro.2016.11.002

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