High-volume Prostate Biopsy Core Involvement is Not Associated with an Increased Risk of Cancer Recurrence Following 5-Fraction Stereotactic Body Radiation Therapy Monotherapy

Purpose Percentage of positive cores involved on a systemic prostate biopsy has been established as a risk factor for adverse oncologic outcomes and is a National Comprehensive Cancer Network (NCCN) independent parameter for unfavorable intermediate-risk disease. Most data from a radiation standpoint was published in an era of conventional fractionation. We explore whether the higher biological dose delivered with SBRT can mitigate this risk factor. Methods A large single institutional database was interrogated to identify all patients diagnosed with localized prostate cancer (PCa) treated with 5-fraction SBRT without ADT. Pathology results were reviewed to determine detailed core involvement as well as Gleason score (GS). High-volume biopsy core involvement was defined as ≥ 50%. Weighted Gleason core involvement was reviewed, giving higher weight to higher-grade cancer. The PSA kinetics and oncologic outcomes were analyzed for association with core involvement. Results From 2009 to 2018, 1590 patients were identified who underwent SBRT for localized PCa. High-volume core involvement was a relatively rare event observed in 19% of our cohort, which was observed more in patients with small prostates ( p < 0.0001) and/or intermediate-risk disease ( p = 0.005). Higher PSA nadir was observed in those patients with low-volume core involvement within the intermediate-risk cohort ( p = 0.004), which was confirmed when core involvement was analyzed as a continuous variable weighted by Gleason score ( p = 0.049). High-volume core involvement was not associated with biochemical progression ( p = 0.234). Conclusions With a median follow-up of over 4 years, biochemical progression was not associated with pretreatment high-volume core involvement for patients treated with 5-fraction SBRT alone. In the era of prostate SBRT and MRI-directed prostate biopsies, the use of high-volume core involvement as an independent predictor of unfavorable intermediate risk disease should be revisited.