Impact of Early Confirmatory Tests on Upgrading and Conversion to Treatment in Prostate Cancer Patients on Active Surveillance

Ginsburg, Kevin; Jacobs, J.; Qi, Ji; Kaye, Deborah R.; Eggly, Susan; Linsell, Susan; Auffenberg, Gregory B.; George, Arvin; Montie, James E.; Cher, Michael L.; Collaborative, Michigan Urological Surgery Improvement

doi:10.1016/j.urology.2020.07.067

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…The primary independent variable was the type and result of the confirmatory testing. The Roadmap denotes the results of confirmatory tests as RA versus non‐RA 7,8 . Non‐RA confirmatory tests were defined as: MRI: PIRADS ≥ 4. Genomics: (1) Prolaris: >3% probability of prostate cancer mortality; (2) OncoType Dx—<80% freedom from primary Gleason 4; (3) Decipher score >0.45. pMRI‐CBx: (1) if the diagnostic biopsy was GG1, then any volume GG2 disease was considered non‐RA.…”

Section: Methodsmentioning

confidence: 99%

“…The Roadmap denotes the results of confirmatory tests as RA versus non-RA. 7,8 Non-RA confirmatory tests were defined as:…”

Section: Study Objectivesmentioning

confidence: 99%

“…Previous work from MUSIC has demonstrated that the additional data point from the results of an early confirmatory test (RA vs. non-RA) can influence treatmentrelated medical-decision making as well as aid in risk stratification of surveillance outcomes. [7][8][9] Since the publication of the Roadmap, MRI has also become prevalent in the management of men with the suspicion of or newly diagnosed prostate cancer. [10][11][12][13] As the use of MRI becomes increasing more prevalent, there is increasing need to understand the influence of additional confirmatory test results (GC and pMRI-CBx) above and beyond that of the MRI result alone.…”

Section: Introductionmentioning

confidence: 99%

“…The results of these tests, which can be classified as reassuring (RA) or non‐reassuring (non‐RA), may influence decision‐making. Previous work from MUSIC has demonstrated that the additional data point from the results of an early confirmatory test (RA vs. non‐RA) can influence treatment‐related medical‐decision making as well as aid in risk stratification of surveillance outcomes 7–9 …”

Section: Introductionmentioning

confidence: 99%

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The added influence of genomics and post‐MRI confirmatory biopsy results to MRI results alone on medical decision making for men with favorable risk prostate cancer being considered for active surveillance

Wang

George

et al. 2022

The Prostate

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Background: We examined how the results of genomic classifier (GC) or postmagnetic resonance imaging confirmatory biopsy (pMRI-CBx) influenced management strategy for men with an MRI considering active surveillance (AS). Methods:We reviewed the Michigan Urological Surgery Improvement Collaborative registry for men with favorable-risk prostate cancer. Among men with an MRI after the diagnostic biopsy (n = 1162) a subset also had GC (n = 126) or pMRI-CBx (n = 309). Results of MRI, GC, and pMRI-CBx were deemed reassuring (RA) or non-reassuring (Non-RA). We assess the association of the combination of test results obtained with the selection of AS.Proportions were compared with the Fisher's exact test. Multivariable logistic regression models were fit for an association of test results with the selection of AS. Results:The results of pMRI-CBx tended to influence management decisions greater than that of GC, especially in situation where testing results were discordant with the MRI result. Fewer men with a RA MRI and non-RA pMRI-CBx where managed with AS compared with RA MRI alone (31% vs. 86%, p < 0.001). non-RA genomics did not seem to have the same influence on management as non-RA pMRI-CBx as a similar proportion of men with RA MRI and non-RA genomics were managed with AS compared with RA MRI alone (85% vs. 86%, p = 0.753). More men with non-RA MRI and RA pMRI-CBx were managed with AS compared with non-RA MRI alone (89% vs. 40%, p < 0.001).Alternatively, a similar proportion of men with non-RA MRI and RA genomics were managed with AS compared with non-RA MRI alone (42% vs. 40%, p > 0.999). In the multivariable models, pMRI-CBx results influenced the decision for AS versus treatment. Conclusions:In men with newly diagnosed prostate cancer and an MRI, the additional information provided by pMRI-CBx influenced the decision of AS versus treatment, while the addition of GC results were less influential.

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Section: Methodsmentioning

confidence: 99%

“…The Roadmap denotes the results of confirmatory tests as RA versus non-RA. 7,8 Non-RA confirmatory tests were defined as:…”

Section: Study Objectivesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The added influence of genomics and post‐MRI confirmatory biopsy results to MRI results alone on medical decision making for men with favorable risk prostate cancer being considered for active surveillance

Wang

George

et al. 2022

The Prostate

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“…The MUSIC group has published their experience with use of confirmatory tests such as repeat biopsy, MRI, and/or genomic classifiers in low risk disease. 1 This high patient acceptance rate in GG2 FIRPC probably also requires innovative and intensive patient counseling processes. I am sure there are valuable lessons to be learned from these practices.…”

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confidence: 99%

Editorial Comment

Morash

2023

Journal of Urology

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Upgrading on Per Protocol versus For Cause surveillance prostate biopsies: An opportunity to decreasing the burden of active surveillance

et al. 2023

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Background Most prostate cancer (PC) active surveillance (AS) protocols recommend “Per Protocol” surveillance biopsy (PPSBx) every 1–3 years, even if clinical and imaging parameters remained stable. Herein, we compared the incidence of upgrading on biopsies that met criteria for “For Cause” surveillance biopsy (FCSBx) versus PPSBx. Methods We retrospectively reviewed men with GG1 PC on AS in the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry. Surveillance prostate biopsies obtained 1 year after diagnosis were classified as either PPSBx or FCSBx. Biopsies were retrospectively deemed FCSBx if any of these criteria were met: PSA velocity > 0.75 ng/mL/year; rise in PSA > 3 ng from baseline; surveillance magnetic resonance imaging (MRI) (sMRI) with a PIRADS ≥ 4; change in DRE. Biopsies were classified PPSBx if none of these criteria were met. The primary outcome was upgrading to ≥GG2 or ≥GG3 on surveillance biopsy. The secondary objective was to assess for the association of reassuring (PIRADS ≤ 3) confirmatory or surveillance MRI findings and upgrading for patients undergoing PPSBx. Proportions were compared with the chi‐squared test. Results We identified 1773 men with GG1 PC in MUSIC who underwent a surveillance biopsy. Men meeting criteria for FCSBx had more upgrading to ≥GG2 (45%) and ≥GG3 (12%) compared with those meeting criteria for PPSBx (26% and 4.9%, respectively, p < 0.001 and p < 0.001). Men with a reassuring confirmatory or surveillance MRI undergoing PPSBx had less upgrading to ≥GG2 (17% and 17%, respectively) and ≥GG3 (2.9% and 1.8%, respectively) disease compared with men without an MRI (31% and 7.4%, respectively). Conclusions Patients undergoing PPSBx had significantly less upgrading compared with men undergoing FCSBx. Confirmatory and surveillance MRI seem to be valuable tools to stratify the intensity of surveillance biopsies for men on AS. These data may help inform the development of a risk‐stratified, data driven AS protocol.

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Impact of Early Confirmatory Tests on Upgrading and Conversion to Treatment in Prostate Cancer Patients on Active Surveillance

Cited by 10 publications

References 14 publications

The added influence of genomics and post‐MRI confirmatory biopsy results to MRI results alone on medical decision making for men with favorable risk prostate cancer being considered for active surveillance

The added influence of genomics and post‐MRI confirmatory biopsy results to MRI results alone on medical decision making for men with favorable risk prostate cancer being considered for active surveillance

Editorial Comment

Upgrading on Per Protocol versus For Cause surveillance prostate biopsies: An opportunity to decreasing the burden of active surveillance

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