Introduction

Repeat prostate biopsies in active surveillance patients are associated with significant complications. Novel imaging and blood/urine based non-invasive tests are being developed to better predict disease grade and volume progression. We conducted a theoretical study to determine what test performance characteristics and costs would a non-invasive test(s) require in order for patients and their physicians to comfortably avoid biopsy.

Methods

Surveys were administered to two populations to determine an acceptable false-negative rate and cost for such test(s). AS patients were recruited at time of visit to the prostate cancer clinic at Princess Margaret Cancer Centre, beginning August 2015 for a period of four months. Responses from urologic oncologists worldwide were obtained in March 2016 by circulating an online survey via the Society of Urologic Oncology. Participants were questioned about their demographics and other characteristics that might influence chosen error rates and cost. Differences between patient and physician choices were tested using the Chi-square test.

Results

136 patients and 670 physicians were surveyed, with 130 (96%) and 104 (16%) responses obtained, respectively. 90.6% of patients were comfortable with a non-invasive test(s) in place of biopsy, with 64.8% accepting a false-negative rate of 5% or worse. 25.8% of patients requested a FN rate of 1% or lower. 93.3% of physicians were comfortable with a non-invasive test, with 77.9% accepting a rate of 5% or worse. 15.4% of physicians requested a FN rate of 1% or lower. 75% of patients and 77% of physicians felt that a cost of less than $1,000, per administration, would be reasonable. No significant differences existed between patient and physicians choices for FN rate or costs (p>0.05).

Conclusions

Most patients/physicians are comfortable with a non-invasive test(s). Although a 5% error rate seems acceptable to many, a substantial subset feels that 99% or higher negative predictive value is required. Thus, a personalized approach with shared-decision making between patients and physicians is essential to optimize patient care in such situations.

Funding

None