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Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study.
Sandahl, Mads; Pedersen, Bodil Ginnerup; Ulhøi, Benedicte Parm; Borre, Michael; Sørensen, Karina Dalsgaard.
Affiliation
  • Sandahl M; Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
  • Pedersen BG; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Ulhøi BP; Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
  • Borre M; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Sørensen KD; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
BJU Int ; 128(6): 702-712, 2021 12.
Article in En | MEDLINE | ID: mdl-33964113
OBJECTIVE: To investigate whether a risk score for prostate cancer (PCa) lifetime risk can be used to optimise triaging of patients with a negative prostate biopsy, but under sustained suspicion of PCa. PATIENTS AND METHODS: In this prospective clinical study, we included, and risk scored patients who had a PCa-negative transrectal ultrasonography (TRUS)-guided prostate biopsy, but elevated prostate-specific antigen (PSA), a suspicious prostate digital rectal examination and/or a positive family history (FH) of PCa. The risk score estimated individual lifetime risk of PCa, based on a polygenic risk score (33 single nucleotide polymorphisms), age, and FH of PCa. Patients were followed, under urological supervision, for up to 4 years with annual controls, always including PSA measurements. Multiparametric magnetic resonance imaging (mpMRI) and/or prostate biopsy was performed at selected annual controls depending on risk score and at the urologist's/patient's discretion, which means that the follow-up differed based on the risk score. RESULTS: We included 429 patients. After risk scoring, 376/429 (88%) patients were allocated to a normal-risk group (<30% PCa lifetime risk) and 53/429 (12%) to a high-risk group (≥30% PCa lifetime risk). The high-risk group had significantly different follow-up, with more biopsy and mpMRI sessions compared to the normal-risk group. PCa was detected in 89/429 (21%) patients, with 67/376 (18%) patients diagnosed in the normal-risk group and 22/53 (42%) in the high-risk group. There was no statistically significant difference in the cumulative incidence of PCa between the normal-risk group and the high-risk group after 4 years of follow-up. Currently, 67/429 (16%) patients are still being followed in this ongoing study. CONCLUSION: In a 4-year perspective, our PCa lifetime risk score did not demonstrate significant prognostic value for triaging patients, with a negative TRUS-guided biopsy and sustained suspicion of PCa.
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Full text: 1 Database: MEDLINE Main subject: Prostate / Prostatic Neoplasms / Prostate-Specific Antigen Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Aged / Humans / Male / Middle aged Language: En Journal: BJU Int Journal subject: UROLOGIA Year: 2021 Type: Article Affiliation country: Denmark

Full text: 1 Database: MEDLINE Main subject: Prostate / Prostatic Neoplasms / Prostate-Specific Antigen Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Aged / Humans / Male / Middle aged Language: En Journal: BJU Int Journal subject: UROLOGIA Year: 2021 Type: Article Affiliation country: Denmark