Negative biopsies may mean positive outcomes for prostate cancer patients

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  • Treatment for prostate cancer may have negative side-effects and is often delayed in the early stages
  • This delay is known as active surveillance, during which patients may have either negative or positive biopsies
  • A recent study shows that negative biopsies may indicate lower rates of cancer progression

Prostate cancer tends to grow very slowly, meaning that some men won’t require treatment, according to the American Cancer Society.

Active surveillance 

These men are said to be low risk, and instead of starting treatment, doctors recommend active surveillance which involves prostate-specific antigen (PSA) blood tests, digital rectal exams (DRE) and also multiple prostate biopsies.

The goal of relying on active surveillance is to delay treatment for as long as possible and only initiating treatment if symptoms worsen. The advantage of this approach is avoiding common side effects of treatment like erectile dysfunction and incontinence.

The significance of negative biopsies 

In some cases, patients undergoing active surveillance have negative biopsies (where no cancer is found). The significance of negative biopsies has only recently been established according to a study in The Journal of Urology

Researchers from the Department of Urology at the University of California, San Francisco evaluated the long-term significance of negative biopsies. They analysed 514 men who were undergoing active surveillance between 2000 and 2019 for early-stage prostate cancer.

Each of the men had a total of four biopsies with an average follow up time of ten years. Of the men, 112 (22%) had at least one negative biopsy, while 78 (15%) had consecutively negative biopsies during active surveillance.

Results of the study concluded that those with consecutively negative biopsies were associated with favourable clinical risk factors. Leading author of the study, Dr Chu explained that “negative biopsies indicate low-volume disease and lower rates of disease progression”.

Dr Chu went on to say, "These 'hidden' cancers have excellent long-term outcomes and remain ideal for continued active surveillance."

What does this mean for prostate cancer patients?

Although consecutive negative biopsies show promise, it does not necessarily mean the cancer has vanished. It is still possible for men with consecutive negative biopsies to be diagnosed later with a higher stage of cancer.

Dr Chu recommends that a less-intensive form of surveillance be continued in such individuals, in order to monitor their health over time.

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