How fusion Bx affects prostate Ca management

Boston-Findings from a retrospective analysis of data collected at the National Institutes of Health (NIH) provide insight on how multiparametric MRI/transrectal ultrasound-fusion biopsy (“fusion biopsy”) may be affecting management patterns and outcomes for men with prostate cancer.

The study identified 1,260 men who underwent a first fusion biopsy followed by systematic biopsy at the NIH.

Prostate cancer was detected in 721 men (57.2%). Among 465 men with localized disease who had data available on chosen treatment and outcomes, 206 (44.3%) enrolled on active surveillance, 204 (43.9%) underwent radical prostatectomy, and 55 (11.8%) received radiation therapy.

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Comparisons between the treatment groups showed men who received radiation were significantly older and had a significantly higher PSA level than their counterparts electing for active surveillance or who had radical prostatectomy. The study also found that men whose Gleason score was upgraded based on fusion biopsy compared with the systematic biopsy were significantly more likely to choose definitive therapy over active surveillance than men whose results were the same with the two techniques or who had a higher grade on systematic versus fusion biopsy.

In addition, “compared with historical cohorts from the CaPSURE and SEER studies in which prostate cancer was diagnosed by systematic biopsy, the percentage of men choosing active surveillance was higher in the fusion biopsy cohort,” said Joseph A. Baiocco, medical research scholar at the NIH’s Urologic Oncology Branch, Bethesda, MD, and a medical student at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia.

“One possible explanation for this difference is that physicians are more confident that the fusion biopsy gives an accurate assessment of disease burden. Consequently, based on its findings, physicians and patients are more comfortable choosing active surveillance,” he told Urology Times. Baiocco worked on the study with Peter A. Pinto, MD, and colleagues.

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The authors, however, noted that further study is needed to determine whether fusion biopsy is modulating management decisions for prostate cancer.

“It is unclear whether the treatment pattern in our cohort is different from the historical controls because decisions were informed by results of fusion biopsy or because we know more now than before about prostate cancer and active surveillance,” said co-author Abhinav Sidana, MD, urologic oncology fellow at the NIH. “The answer may come when more institutions do a study like ours.”

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Cancer outcomes were analyzed based on findings of progression on second biopsy or biochemical recurrence after definitive therapy. The 2-year and 5-year rates of progression-free/biochemical recurrence-free survival were 77.5% and 45.3%, respectively, among men in the active surveillance group; 88.1% and 69.0%, respectively, for men who underwent radical prostatectomy; and 100% and 93%, respectively, in the radiotherapy group.

“There has been a lack of research on prostate cancer outcomes in patients diagnosed with fusion biopsy. To our knowledge, this is the first report of short-term and intermediate-term outcomes in a cohort of men with prostate cancer diagnosed by fusion biopsy,” said Dr. Sidana.

The findings were presented at the 2017 AUA annual meeting in Boston.