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Introduction and Objective: Active surveillance protocols, which monitor prostate specific antigen (PSA) levels and histological grading, have been developed as a less invasive alternative to curative procedures in patients with low risk prostate cancer. Active surveillance guidelines have been established, but the experience of urologists and their patients can differ greatly. We aimed to describe in detail the experience in an active surveillance cohort of 114 patients. PSA levels and rates were compared with biopsy intervals to quantify the influence of PSA levels and rates on the timing of repeat biopsies.

Methods: A chart review was conducted on 114 patients who undertook active surveillance between 2001 and 2012. Biopsy intervals and PSA intervals and values were extracted from patient charts. Pre-biopsy PSA rates and levels were compared to biopsy intervals using Pearson correlation analysis (Prism software).

Results: Of 114 patients on active surveillance 53 underwent 2 or more biopsies, 44 patients had 2 or more PSA levels recorded between biopsy 1 and biopsy 2. The average biopsy interval was 16.5 months (range: 3 - 37). The mean PSA rate between 1st and 2nd biopsies was 0.9/month (range: -1.19 - 1.3) and the average pre-biopsy PSA level was 5.19 (range: 0.3 - 10.9). Pearson’s correlation coefficient between PSA rate and biopsy interval for 44 subjects was 0.06 (p=0.7161). However, a strong relationship between pre-biopsy PSA level and biopsy interval was demonstrated (52 subjects); Pearson’s correlation coefficient was -0.4383 (p=0.012).
Conclusion: The rate of change of PSA levels did not correlate with biopsy interval, which was 4.5 months greater than CUA suggested guidelines. However, PSA level was strongly related to the timing of the second biopsy. Therefore PSA values influenced the physician/patient to obtain a repeat biopsy sooner, but the rate of PSA increase did not impact this decision.