Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a
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Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort Francesco Giganti 1,2 & Armando Stabile 2,3 & Vasilis Stavrinides 2,4 & Elizabeth Osinibi 2 & Adam Retter 1,2 & Clément Orczyk 2,4 & Valeria Panebianco 5 & Bruce J. Trock 6 & Alex Freeman 7 & Aiman Haider 7 & Shonit Punwani 1,8 & Clare Allen 1 & Alex Kirkham 1 & Mark Emberton 2,4 & Caroline M. Moore 2,4 Received: 1 July 2020 / Revised: 28 July 2020 / Accepted: 1 September 2020 # The Author(s) 2020
Abstract Objectives The PRECISE recommendations for magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer (PCa) include repeated measurement of each lesion, and attribution of a PRECISE radiological progression score for the likelihood of clinically significant change over time. We aimed to compare the PRECISE score with clinical progression in patients who are managed using an MRI-led AS protocol. Methods A total of 553 patients on AS for low- and intermediate-risk PCa (up to Gleason score 3 + 4) who had two or more MRI scans performed between December 2005 and January 2020 were included. Overall, 2161 scans were retrospectively re-reported by a dedicated radiologist to give a PI-RADS v2 score for each scan and assess the PRECISE score for each follow-up scan. Clinical progression was defined by histological progression to ≥ Gleason score 4 + 3 (Gleason Grade Group 3) and/or initiation of active treatment. Progression-free survival was assessed using Kaplan-Meier curves and log-rank test was used to assess differences between curves. Results Overall, 165/553 (30%) patients experienced the primary outcome of clinical progression (median follow-up, 74.5 months; interquartile ranges, 53–98). Of all patients, 313/553 (57%) did not show radiological progression on MRI (PRECISE 1–3), of which 296/313 (95%) had also no clinical progression. Of the remaining 240/553 patients (43%) with radiological progression on MRI (PRECISE 4–5), 146/240 (61%) experienced clinical progression (p < 0.0001). Patients with radiological progression on MRI (PRECISE 4-5) showed a trend to an increase in PSA density. Conclusions Patients without radiological progression on MRI (PRECISE 1-3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07256-z) contains supplementary material, which is available to authorized users. * Francesco Giganti [email protected] 1
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Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK Division of Surgery & Interventional Science, University College London, 3rd Floor, Charles Bell House, 43-45 Foley St., London W1W 7TS, UK Department of Urology and Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
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Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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Department of Ra
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