Is a Confirmatory Prostate Biopsy Still Necessary for Active Surveillance of Men with Grade Group 1 Prostate Cancer when MRI is Available?

Confirmatory biopsy is recommended for men diagnosed with prostate cancer who are considering active surveillance. Now that MRI-informed biopsy is widely available, is this necessary? In this study, men with Grade Group (GG) 1 prostate cancer at diagnosis underwent MRI and confirmatory biopsy within eighteen months. Outcomes included grade reclassification to GG≥2 and GG≥ 3 and reclassification to unfavorable intermediate-risk disease.

Reclassification rates at confirmatory biopsy were high in men with a positive MRI but <10% for all reclassification outcomes in men with a negative MRI. The study results support systematic, targeted confirmatory biopsy for men with positive MRI findings who are considering active surveillance. Men with GG1 cancer and a negative MRI should be able to defer a confirmatory biopsy.

J Urol. Jan. 2025. https://doi.org/10.1097/JU.0000000000004268