A Comparison of Periodic Rebiopsy versus Patient-Based Rebiopsy in Prostate Cancer Active Surveillance

IntroductionIn low-risk prostate cancer (PCa), the aim of active surveillance (AS) is to reduce overtreatment and avoid potential adverse effects. The rebiopsy approach in AS remains debated, spanning routine scheduled biopsies to clinically- or imaging-driven rebiopsies based on PSA kinetics or multiparametric MRI (mpMRI). In this retrospective, single-center comparative cohort study, we examined outcomes of periodic vs patient-based rebiopsy during AS and evaluated oncological outcomes in patients with PCa.MethodsSeventy-four patients who underwent at least one year of AS for PCa between January 2019 and July 2024 were retrospectively analyzed. Two distinct AS protocol patients were included in the study from 4 different physicians in our clinic. Demographic data, PSA levels, PSA kinetics, mpMRI findings, and rebiopsy pathology results were documented. Radical prostatectomy (RP) pathology results and factors influencing definitive treatment (DT) decisions were compared between the 2 groups: periodic rebiopsy (n = 41), and patient-based rebiopsy (n = 33).ResultsThe median rebiopsy time was shorter in the periodic group (12.5 months, IQR: 1) than in the patient-based group (14 months, IQR: 9; P < 0.001). First-year rebiopsies were more frequent in the periodic group (68.3%) than in the patient-based group (45.5%; P = 0.048). No significant difference in DT switching rates or final pathology outcomes was observed, though patients in the periodic group switched to DTs earlier (P = 0.045). A positive Spearman's correlation was identified between the maximum PSA density and the International Society of Urological Pathology (ISUP) score of RP specimens [rho = 0.62, P = 0.001]. A PSA density cut-off value of ≥0.17 ng/mL² was found to predict an ISUP grade ≥2 in the final pathological assessment with high accuracy (AUC = 0.891, 95% CI: 0.753-1.00, P = 0.003).ConclusionsPatient-based rebiopsy protocols driven by PSA kinetics and mpMRI results can minimize unnecessary procedures, prevent overtreatment, and optimize monitoring in AS of PCa.