245 SHOULD STAGING TRANSRECTAL SATURATION BIOPSY BE A STANDARD FOR ASSESSMENT OF DISEASE PROGRESSION & FOLLOW UP FOR PROSTATE CANCER PATIENTS ON ACTIVE SURVEILLANCE?

INTRODUCTION AND OBJECTIVES: Prostate cancer (PCa) aggressiveness assessment is mandatory to determine the appropriateness for Active surveillance (AS). Our objective is to assess the accuracy of staging saturation prostate biopsy (SB) compared to extended prostate biopsy (EB) in patients on AS protocol. METHODS: From IRB approved database we reviewed 485 biopsies from 383 patients diagnosed with PCa on AS protocol from 2000-2011. Gleason sum ,total gland volume ,number of positive cores, maximum cancer % per core, prostate specific antigen (PSA) at time of the biopsy, % free PSA ,high grade prostatic intraepithelial neoplasia(HGPIN) and atypical small acinar cell proliferation (ASAP) were assessed as predictors of cancer progression. We compared the ability of each template to identify Gleason 7 diseases, 2 core involvement and 50% cancer involvement in each core. RESULTS: Among 485 biopsies ,288 were EB (8-14 cores) and 197 were SB( 20 cores) .Our univariate analysis showed that the “recategorization” identified with SB is greater as evidence by gleason 7 disease (p 0.0004) and 2 core involvement (p 0.002) . We also found that the presence of HGPIN (p 0.03) and PSA at time of the biopsy (p 0.02) were statistically significant compared to EB (table 1). Moreover multivariate analysis showed that SB identified higher Gleason ( 7) disease (p 0.04) and number of positive cores ( 2 cores) (p 0.02). (Table 2). CONCLUSIONS: Staging SB identifies more accurately PCa progression in patients electing AS for their low grade, low volume PCa compared to EB. We recommend using SB ( 20 cores) as a standard protocol for patients on AS.