The Risk of Prostate Cancer Progression in Active Surveillance Patients With Bilateral Disease Detected by Combined MRI-Fusion and Systematic Biopsy.

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To evaluate whether bilateral prostate cancer detected at Active Surveillance (AS) enrollment is associated with progression to Grade Group ≥2 (GG2) and to compare the efficacy of combined targeted biopsy plus systematic biopsy (CBx) versus systematic biopsy (Sbx) or targeted biopsy (Tbx) alone to detect bilateral disease.A prospectively-maintained database of patients referred to our institution from 2007-2020 was queried. The study cohort included all AS patients with GG1 on confirmatory Cbx and follow-up of at least one year. Cox proportional hazard analysis identified baseline characteristics associated with progression to GG ≥2 at any point throughout follow-up.Of 579 patients referred, 103 patients had GG1 on Cbx and were included in the study. 49/103 (47.6%) patients progressed to ≥GG2, with 30/72 (41.7%) patients with unilateral disease progressing and 19/31 (61.3%) patients with bilateral disease progressing. Median time to progression was 68 months vs. 52 months for unilateral and bilateral disease, respectively (p=0.006). Both PSA Density (HR 1.72, p=0.005) and presence of bilateral disease (HR 2.21, p=0.012) on confirmatory biopsy were associated with AS progression. At time of progression, GG and risk group were significantly higher in patients with bilateral versus unilateral disease. Cbx detected 16% more patients with bilateral disease than Sbx alone.Bilateral disease and PSA Density at confirmatory Cbx conferred greater risk of earlier AS progression. Cbx was superior to Sbx for identifying bilateral disease. AS risk-stratification protocols may benefit from including presence of bilateral disease and should use Cbx to detect bilateral disease.

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Authors: Cheyenne Williams, Nabila R Khondakar, Michael A Daneshvar, Luke P O’Connor, Patrick T Gomella, Sherif Mehralivand, Nitin K Yerram, Jillian Egan, Sandeep Gurram, Alexis Rompré-Brodeur, Bradley R Webster, Jeunice Owens-Walton, Howard Parnes, Maria J Merino, Bradford J Wood, Peter Choyke, Baris Turkbey, Peter A Pinto