How to tell when localized cancer is advancing

Repeat prostate biopsies can help detect disease progression in men diagnosed with early-stage prostate cancer pursuing active surveillance. But whether repeat biopsies are really needed — and if so, when they should be done — are unanswered questions. To add to the debate, British researchers studied 119 men with untreated disease who had a biopsy to diagnose the condition and a follow-up biopsy 18 to 24 months later. Among the 28% of patients whose disease advanced, two histological factors proved key predictors of cancer progression: PSA density of 0.2 ng/ml/ml or greater (PSA density is the PSA level in the blood divided by the volume of the prostate), and any tissue sample considered 15% cancerous or more. As a result, the researchers conclude that a repeat biopsy should be an integral part of active surveillance for untreated, localized prostate cancer. They also recommend considering an immediate repeat biopsy for patients with a PSA density greater than 0.2 ng/ml/ml.

Source: Venkitaraman R, Norman A, Woode-Amissah R, et al. Predictors of Histological Disease Progression in Untreated, Localized Prostate Cancer. Journal of Urology 2007;178:833–37. PMID: 17631355.