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    Surveillance: Reclassification risk drops after 2 years

    Findings could lead to greater intervals between biopsies in low-risk patients

    Baltimore—New findings from the Johns Hopkins University School of Medicine in Baltimore should be useful to clinicians looking to counsel anxious prostate cancer patients who are undergoing active surveillance. 

    Read: ASCO endorses prostate Ca active surveillance guideline

    Analyses of data from the prospectively maintained Johns Hopkins Active Surveillance Study show that reclassification rates are not equally distributed across time or risk groups, researchers reported at the 2015 AUA annual meeting in New Orleans.

    Their study, which was subsequently published in the Journal of Urology (2015; 193:1950-5), included data from 808 men enrolled since January 2005 who were compliant with all follow-up biopsies, of whom 557 were categorized as very low risk and 251 were low risk. Kaplan-Meier survival analysis with adjustments for covariates using a Cox proportional hazards model was done to estimate freedom from reclassification.

    Reclassification risk highest 2 years post-Dx

    The results showed the risk of reclassification, defined as either increase in grade or volume, was highest in the first 2 years after diagnosis and was similar comparing the very low-risk and low-risk subgroups. Thereafter, the risk of reclassification by grade or volume was significantly higher in the low-risk men than in the very-low-risk subgroup (2.4-fold and 1.8-fold, respectively). In both cohorts, however, the lifetime risk declined exponentially, falling by 30% with each favorable biopsy in the low-risk subgroup and by 35% in the very-low-risk men.

    Next: Findings "allow clinicians to provide patients with confident answers and to reassure men"

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