Active Surveillance Magnetic Resonance Imaging Study (ASIST): Results of a Randomized Multicenter Prospective Trial

Klotz, Laurence; Loblaw, Andrew; Sugar, Linda; Moussa, M. Abi; Berman, David M.; Kwast, Theo van der; Vesprini, Danny; Milot, Laurent; Kebabdjian, Marlene; Fleshner, Neil; Ghai, Sangeet; Chin, J.; Pond, Gregory R.; Haider, Masoom A.

doi:10.1016/j.eururo.2018.06.025

Cited by 113 publications

(73 citation statements)

References 15 publications

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“…Similarly, the initial results from the ASIST trial in men on AS did not show a significant improvement in the detection of GG ≥ 2 PCa upon addition of mpMRI, although the authors did report significant differences in upgrading rates across sites. Their most experienced site with a consistent operator had a higher detection rate of 33% for GG ≥ 2 PCa in the mpMRI arm compared to 20% in the systematic biopsy arm (one-sided P = 0.049), while in the less experienced sites with several different operators the upgrading rate for men in mpMRI arm was at least 15% lower than men in systematic biopsy arm [13]. However, the recently published 2-year followup report from the ASIST trial indeed found that men in the MRI arm had significantly fewer upgrades than men in the TRUS arm (10% vs 23%, P = 0.048) [14].…”

Section: Discussionmentioning

confidence: 93%

“…The pre-mpMRI-era group underwent a median (IQR) of 3 (2-5) surveillance biopsies, whereas both the mpMRI groups had a median (IQR) of 2 (2-3) surveillance biopsies. The median (IQR) interval between surveillance biopsies was 12 (12)(13)(14) months in the pre-MRI-era group and 13 (12)(13)(14)(15)(16) months in the two mpMRI groups. There was no significant difference in the frequency and interval of biopsies between the negative mpMRI and PI-RADS ≥ 3 groups (P = 0.9).…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies have found that for men on AS, a positive mpMRI is more likely to be associated with upgrading to Grade Group (GG) ≥2 than a negative mpMRI [10,11], and that a mpMRI with a Prostate Imaging-Reporting and Data System (PI-RADS) score of > 3 has a positive predictive value of over 60% for the detection of GG ≥ 2 PCa [12]. On the contrary, initial results from a prospective, randomised, trial (ASIST; Active Surveillance Magnetic Resonance Imaging Study) demonstrated that addition of mpMRI to an AS regimen did not significantly improve the detection rate of GG ≥ 2 PCa over the standard TRUS biopsies alone [13]. However, the recently published 2-year post-biopsy follow-up report from the ASIST trial has shown that the use of mpMRI before confirmatory biopsy resulted in lesser progression to GG ≥ 2 PCa [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

et al. 2020

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ObjectiveTo assess if the adoption of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) has improved the identification of occult higher-grade prostate cancer (PCa). Patients and MethodsWe retrospectively identified men from the Johns Hopkins AS registry enrolled since 2013 (year of mpMRI adoption) with Grade Group (GG) 1 PCa and who underwent a single mpMRI. Men in this group were dichotomised by the presence (n = 207) or absence (negative mpMRI, n = 225) of one or more lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of ≥ 3. Both groups were compared to a third cohort of men with GG1 PCa enrolled in AS prior to 2013 (pre-mpMRI era, n = 669). The risk of upgrading to GG ≥ 2 PCa on follow-up biopsies (performed with or without MRI targeting) was evaluated among the groups using survival analysis. ResultsMen in both mpMRI groups underwent a median (interquartile range [IQR]) of 2 (2-3) biopsies separated by a median (IQR) interval of 13 (12-16) months, whereas men in the pre-MRI era underwent a median (IQR) of 3 (2-5) biopsies, separated by a median (IQR) interval of 12 (12-14) months. The 2-and 4-year upgrade-free survival rates were 93% and 83%, 74% and 59%; and, 87% and 76% for the negative mpMRI, PI-RADS ≥ 3, and pre-mpMRI-era groups, respectively (P < 0.001). On multivariable analysis, both mpMRI groups had significantly different risk of upgrading compared to pre-mpMRI-era group (negative mpMRI group: hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39-0.95, P = 0.03; PI-RADS ≥ 3 group: HR 1.96, 95% CI 1.36-2.82, P < 0.001). ConclusionsmpMRI improves the risk stratification of men on AS and should be used to aid enrolment and monitoring decisions.

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Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

et al. 2020

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“…Furthermore, upgrading to Gleason 7 was seen in 19/137 men (14%) in the MRI arm on targeted biopsy alone compared with 31/136 patients (23%) in the systematic biopsy arm, with a suggested trend towards less upgrading in the targeted (i.e. two‐core) arm ( P = 0.09) .…”

Section: Resultsmentioning

confidence: 99%

Use of multiparametric magnetic resonance imaging in prostate cancer active surveillance

Glass

Dall′Era

2019

BJU International

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Objectives To review the role of multiparametric magnetic resonance imaging (mpMRI) for active surveillance (AS) of prostate cancer. Materials and Methods We performed a comprehensive search of Medline and Embase databases for relevant articles in the English language. Search terms included ‘prostate cancer', ‘active surveillance' or ‘monitoring', ‘expectant management', and ‘MRI'. We also reviewed practice guidelines from recognized international associations or societies involved in prostate cancer care. Articles were selected by both authors for relevance to the subject matter. Results The ability of mpMRI to visualize primarily high‐grade tumours within the prostate may improve risk stratification for men considering AS for prostate cancer. Multiple mostly single‐institution studies have found that the addition of mpMRI and a targeted biopsy strategy can improve AS patient selection over standard TRUS biopsy alone. The high negative predictive value of mpMRI may allow men to avoid early repeat biopsy and may offer the possibility to tailor biopsy strategies. The presence of a radiographically positive lesion on mpMRI at baseline is predictive of higher likelihood of radiographic progression over time while on AS. Conclusions MRI has shown promise in both patient selection and monitoring for men who undergo AS for prostate cancer. There are multiple barriers to the widespread use of mpMRI for AS including quality, cost and access to care.

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“…4 In addition, a recent prospective multicenter trial demonstrated that MRI-targeted biopsies identified most, but not all, clinically significant cancers. 18 The high negative predictive value of MRI has been used as a rationale for the role of MRI in ruling out clinically significant prostate cancer. In the present study, mpMRI of patients eligible for AS had a negative predictive value of 82%, indicating that mpMRI with PI-RADSv2 could be useful for ruling out clinically significant cancer lesions, consistent with the findings from previous studies.…”

Section: Discussionmentioning

confidence: 99%

Utility of Multiparametric Magnetic Resonance Imaging With PI-RADS, Version 2, in Patients With Prostate Cancer Eligible for Active Surveillance: Which Radiologic Characteristics Can Predict Unfavorable Disease?

Kim

Pak

Park

et al. 2020

Clinical Genitourinary Cancer

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Active Surveillance Magnetic Resonance Imaging Study (ASIST): Results of a Randomized Multicenter Prospective Trial

Cited by 113 publications

References 15 publications

Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

Use of multiparametric magnetic resonance imaging in prostate cancer active surveillance

Utility of Multiparametric Magnetic Resonance Imaging With PI-RADS, Version 2, in Patients With Prostate Cancer Eligible for Active Surveillance: Which Radiologic Characteristics Can Predict Unfavorable Disease?

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