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Low Prostate Cancer–Specific Mortality in Men With Benign Initial Transrectal Ultrasound–Guided Biopsy Sets

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Key Points

  • Prostate cancer–specific mortality was low in men with benign initial biopsy sets.
  • The risk was particularly low in those with a lower PSA value.

In a Danish study reported in The Lancet Oncology, Klemann et al found a low risk of prostate cancer–specific mortality in men with benign initial transrectal ultrasound-guided biopsy sets. The risk was particularly low among those with lower prostate-specific antigen (PSA) levels.

Study Details

The study included data on 63,454 men from the Danish Prostate Cancer Registry referred for transrectal ultrasound-guided biopsy to assess suspected prostate cancer between January 1995 and December 2011. Follow-up data were obtained in April 2015. The primary endpoint was the cumulative incidence of prostate cancer–specific mortality assessed in a competing risk analysis, with death from other causes as the competing event.

Outcomes

Median follow-up was 5.9 years, and total follow-up from enrollment of the first patient in 1995 through April 2015 was 20 years. Death from prostate cancer occurred in 10,407 of 35,159 men (30%) with malignant initial biopsy sets compared with 541 of 27,181 men (2%) with benign initial biopsy sets.

Among all patients, estimated overall 20-year mortality was 76.1%; the cumulative incidence of prostate cancer–specific mortality was 25.6%, compared with 50.5% for mortality from other causes. In those with benign initial biopsy sets, the cumulative incidence of prostate cancer–specific mortality was 5.2%, compared with 59.9% for mortality from other causes. The cumulative incidence of prostate cancer–specific mortality in men with benign initial biopsy sets was 0.7% in those with PSA levels ≤ 10 ng/mL (n = 2,779), 3.6% in those with PSA levels > 10 ng/mL and ≤ 20 ng/mL (n = 855), and 17.6% in those with PSA levels > 20 ng/mL (n = 454).

The investigators concluded: “The first systematic transrectal ultrasound-guided biopsy set holds important prognostic information. The 20-year risk of prostate cancer-specific mortality in men with benign initial results is low. Our findings question whether men with low PSA concentration and a benign initial biopsy set should undergo further diagnostic assessment in view of the high risk of mortality from other causes.”

The study was funded by the Capital Region of Denmark’s Fund for Health Research, the Danish Cancer Society, the Danish Association for Cancer Research, and Krista and Viggo Petersen’s Foundation.

Nina Klemann, MD, of Copenhagen University Hospital, is the corresponding author of The Lancet Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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