TOPLINE

Among patients who underwent active surveillance following transperineal template-guided mapping biopsy (TTMB), only 9% required treatment for prostate cancer over 12 years, and none had distant metastases, a single-center study found.

METHODOLOGY

• Active surveillance is the preferred management for patients with low-risk prostate cancer, but its safety relies on accurate risk assessment. TTMB, which uses ultrasound to create a three-dimensional sampling map of the whole prostate gland, may improve confidence in selecting patients for active surveillance compared with standard transrectal biopsy.
• To look at long-term outcomes with the approach, researchers conducted a prospective cohort study of patients at one US institution. A total of 374 patients with clinical stage cT1c to T2a Grade Group (GG) 1 or selected GG2 prostate cancer underwent baseline TTMB, with a median of 71 biopsy cores taken per patient.
• Follow-up protocols included prostate-specific antigen (PSA) testing every 4 months and an annual digital rectal examination (DRE), with repeat biopsy recommended only for a PSA doubling time of less than 3 years, a change in DRE, or at the patient’s request.
• The primary endpoint was freedom from therapeutic intervention, while secondary endpoints included overall survival and longitudinal quality-of-life measures.

TAKEAWAY

• The 8-year and 12-year landmark cumulative incidences of therapeutic intervention were 5.2% (n = 13) and 8.7% (n = 17), respectively, indicating that more than 90% of patients remained on active surveillance without requiring treatment.
• Among the 18 patients who underwent treatment, 10 (55.6%) were upgraded to GG3 and 5 (27.8%) to GG4 on repeat biopsy. Another three patients (16.7%) underwent treatment for nononcologic reasons. No distant metastases or prostate cancer-related deaths were observed.
• In multivariable analysis, PSA density > 0.15 ng/mL/cm² was associated with therapeutic intervention (subdistribution hazard ratio [HR], 2.93; P = .03).
• Quality-of-life measures were largely steady over time. Overall, urinary and bowel function showed no meaningful decline, depressive symptoms remained stable, and sexual function declined gradually, consistent with aging.

IN PRACTICE

“These findings describe favorable long-term outcomes of [active surveillance] after comprehensive baseline staging,” the study authors wrote. Future studies, they added, should look at whether baseline TTMB can be integrated with MRI and a genomic classifier to personalize surveillance intensity.

SOURCE

The study, led by Mutlay Sayan, MD, of Brigham and Women’s Hospital and Dana Farber Cancer Institute in Boston, was published as a research letter in JAMA Network Open.

LIMITATIONS

The study was conducted at a single institution with a predominantly White cohort, which may limit generalizability. It lacked a comparator arm to assess outcomes against other surveillance strategies. Repeat biopsy was not mandated at fixed intervals, and downstream biopsy and MRI use were not systematically captured, potentially affecting the assessment of disease progression.

DISCLOSURES

No funding source was reported. Several co-authors disclosed financial relationships with Theragenics Corporation and other medical technology companies. Full disclosures are available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.