A Nationwide Analysis of Risk of Prostate Cancer Diagnosis and Mortality following an Initial Negative Transrectal Ultrasound Biopsy with Long-Term Followup

Kawa, Sandra Miriam; Stroomberg, Hein Vincent; Larsen, Signe Benzon; Helgstrand, John Thomas; Toft, Birgitte Grønkær; Vickers, Andrew J.; Brasso, Klaus

doi:10.1097/ju.0000000000002491

Cited by 19 publications

(20 citation statements)

References 22 publications

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“…However, doubt has been cast on whether these cancers are oncologically aggressive. We and other groups have shown that the long‐term risk of prostate cancer death in men with benign systematic biopsies is very low 18,21 ; if MRI targeting identifies many histologically defined Gleason score ≥ 7 tumors in a group of men with low prostate cancer mortality, it is clear that most of the tumors are in fact indolent despite their histology 10 . This suggests that current guidelines on how to histologically evaluate and grade MRI‐targeted biopsies may need revision.…”

Section: Discussionmentioning

confidence: 99%

Risk of prostate cancer and death after benign transurethral resection of the prostate—A 20‐year population‐based analysis

Hilscher

Røder

Helgstrand

et al. 2022

Cancer

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BACKGROUND:The oncological risks after benign histology on a transurethral resection of the prostate (TURP) remain largely unknown.Here, the risk of prostate cancer incidence and mortality following a benign histological assessment of TURP is investigated in a populationbased setting. METHODS: Between 1995 and 2016, 64,059 men in Denmark underwent TURP without prior biopsy of the prostate; 42,558 of these men had benign histology. The risks of prostate cancer, prostate cancer with a Gleason score ≥ 3 + 4, and prostate cancer-specific death were assessed with competing risks. Specific risks for pre-TURP prostate-specific antigen (PSA) levels at 10 and 15 years were visualized by locally estimated scatterplot smoothing. RESULTS: The median age at TURP was 72 years (interquartile range [IQR], 65-78 years), and the median follow-up was 15 years (IQR, 10-19 years). The 10-year risks of any prostate cancer and prostate cancer with a Gleason score ≥ 3 + 4 and the 15-year risk of prostate cancer death showed clear visual relations with increasing PSA. The 15-year cumulative incidence of prostate cancer-specific death after benign TURP was 1.4% (95% confidence interval [CI], 1.3%-1.6%) for all men and 0.8% (95% CI, 0.6%-1.1%) for men with PSA levels <10 ng/ml. The primary limitation was exclusion due to missing PSA data. CONCLUSIONS: Men with low PSA levels and a benign TURP can be reassured about their cancer risk and do not need to be monitored differently than any other men. Patients with high PSA levels can be considered for further follow-up with prostate magnetic resonance imaging. These findings add to the literature suggesting that normal histology from the prostate entails a low risk of death from the disease.

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Section: Discussionmentioning

confidence: 99%

Risk of prostate cancer and death after benign transurethral resection of the prostate—A 20‐year population‐based analysis

Hilscher

Røder

Helgstrand

et al. 2022

Cancer

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“…Finally, although some metachronous tumors maintain molecular subtype membership of initial tumors, 12.5% of metachronous tumors had unmatched subtypes. 1 Considering existing evidence from published studies about the clonal relatedness between UTUC and BUC, 8e10 genomics combined with transcriptomics might still be required to identify a more complete molecular subtype of metachronous and synchronous urothelial carcinomas.…”

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“…To the Editor: We were interested to read the impressive study by Petros et al 1 and would like to congratulate the authors for their excellent findings. The authors used whole transcriptome RNA sequencing to systematically analyze same-patient samples of upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) and divided them into 4 groups: UTUC-metachronous BUC, BUC-metachronous UTUC, synchronous UTUC-BUC and UTUC without BUC (UTUC-only).…”

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“…Second, this study found that most BUC tumors (64.7%) were luminal-like. 1 We believe that one of the reasons for this high percentage of luminal-like gene expression for BUC tumors is because the authors only included nonmuscle-invasive BUC (NMI-BUC) but not muscle-invasive BUC (MI-BUC). Compared with NMI-BUC, MI-BUC is more aggressive and appears with different and complex molecular subtypes.…”

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confidence: 99%

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Expression Analysis of Same-Patient Metachronous and Synchronous Upper Tract and Bladder Urothelial Carcinoma. Letter.

Song

Qin

et al. 2022

Journal of Urology

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“…To the Editor: We read with great interest the work of Kawa et al on prostate cancer diagnosis and survival following a negative transrectal ultrasound-guided biopsy in a large cohort from Denmark. 1 We have previously published in The Journal of Urology ® on survival following negative prostate biopsy using data from the screening arm of the Prostate, Lung, Colorectal, and Ovarian cancer trial, and found a prostate cancer-specific mortality rate of 1.1% at a median followup of 12.9 years. 2 These figures were recently updated, using similar methodology by Pierre-Victor et al, to 1.2% at 16.6 years.…”

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confidence: 99%