Progression and treatment rates using an active surveillance protocol incorporating image guided baseline biopsies and multi-parametric MRI monitoring for men with favourable risk prostate cancer

Thurtle, David; Barrett, Tristan; Thankappannair, Vineetha; Koo, Bo Kyung; Warren, A.; Kastner, Christof; Saeb‐Parsy, Kasra; Kimberley-Duffell, Jenna; Gnanapragasam, V.J.

doi:10.1016/s1569-9056(18)32304-2

Cited by 7 publications

(6 citation statements)

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“…AS = active surveillance; MRI = magnetic resonance imaging. up of 39 mo) [18]. We showed that Gleason grade and MRI visibility at baseline are associated with EFS and treatmentfree survival, a finding previously confirmed by others [17].…”

Section: Discussionsupporting

confidence: 82%

Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study

et al. 2020

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Background Although the use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) for prostate cancer is of increasing interest, existing data are derived from small cohorts. Objective We describe clinical, histological, and radiological outcomes from an established AS programme, where protocol-based biopsies were omitted in favour of MRI-led monitoring. Design, setting, and participants Data on 672 men enrolled in AS between August 2004 and November 2017 (inclusion criteria: Gleason 3 + 3 or 3 + 4 localised prostate cancer, presenting prostate-specific antigen <20 ng/ml, and baseline mpMRI) were collected from the University College London Hospital (UCLH) database. Outcome measurements and statistical analysis Primary outcomes were event-free survival (EFS; event defined as prostate cancer treatment, transition to watchful waiting, or death) and treatment-free survival (TFS). Secondary outcomes included rates of all-cause or prostate cancer–related mortality, metastasis, and upgrading to Gleason ≥4 + 3. Data on radiological and histological progression were also collected. Results and limitations More than 3800 person-years (py) of follow-up were accrued (median: 58 mo; interquartile range 37–82 mo). Approximately 84.7% (95% confidence interval [CI]: 82.0–87.6) and 71.8% (95% CI: 68.2–75.6) of patients remained on AS at 3 and 5 yr, respectively. EFS and TFS were lower in those with MRI-visible (Likert 4–5) disease or secondary Gleason pattern 4 at baseline (log-rank test; p < 0.001). In total, 216 men were treated. There were 24 deaths, none of which was prostate cancer related (6.3/1000 py; 95% CI: 4.1–9.5). Metastases developed in eight men (2.1 events/1000 py; 95% CI: 1.0–4.3), whereas 27 men upgraded to Gleason ≥4 + 3 on follow-up biopsy (7.7 events/1000 py; 95% CI: 5.2–11.3). Conclusions The rates of discontinuation, mortality, and metastasis in MRI-led surveillance are comparable with those of standard AS. MRI-visible disease and/or secondary Gleason grade 4 at baseline are associated with a greater likelihood of moving to active treatment at 5 yr. Further research will concentrate on optimising imaging intervals according to baseline risk. Patient summary In this report, we looked at the outcomes of magnetic resonance imaging (MRI)-based surveillance for prostate cancer in a UK cohort. We found that this strategy could allow routine biopsies to be avoided. Secondary Gleason pattern 4 and MRI visibility are associated with increased rates of treatment. We conclude that MRI-based surveillance should be considered for the monitoring of small prostate tumours.

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Section: Discussionsupporting

confidence: 82%

Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study

et al. 2020

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“…Pre-biopsy multi-parametric prostate magnetic resonance imaging (PB-mpMRI) is commonly performed prior to transrectal prostate biopsy (TRPB) in men with suspected prostate cancer (PCa) following PSA-testing, and in active surveillance (AS) (1)(2)(3). PB-mpMRI indicates regions of interest using the Prostate Imaging Reporting And Data System (PI-RADS) version 2 (4), which can be targeted at TRPB.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Prostate Biopsy with or without Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Detection: An Observational Cohort Study

et al. 2019

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DISCLAIMER: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our subscribers we are providing this early version of the article. The paper will be copy edited and typeset, and proof will be reviewed before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to The Journal pertain. Embargo PolicyAll article content is under embargo until uncorrected proof of the article becomes available online.We will provide journalists and editors with full-text copies of the articles in question prior to the embargo date so that stories can be adequately researched and written. The standard embargo time is 12:01 AM ET on that date. Questions regarding embargo should be directed to

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“…lesions were mostly benign (with only up to 13.8% harboring low-gradeGleason 6 cancer) and did not change significantly in size over approximately 2 years (2.31±1.56 years and 2.40±1.77 years for ≤7 mm and ≤5 mm index lesion thresholds, respectively). From these findings the authors proposed a monitoring interval of at least two years for small lesions.Studies of men already on AS who have had repeat mpMRIs and biopsies are more informative(39)(40)(41)(42)(43)(44)(45)(Table 2). In a retrospective study, Walton-Diaz and colleagues evaluated patients meeting surveillance criteria based on systematic TRUS biopsy, who subsequently underwent further systematic biopsies, mpMRI and TRUS targeted biopsies during AS until Gleason grade progression occurred and treatment was recommended(39).The sensitivity, specificity, negative and positive predictive values were 0.53 (95% CI: 0.28-0.77), 0.80 (95% CI: 0.65-0.91), 0.80 (95% CI: 0.65-0.91), 0.53 (95% CI: 0.28-0.77), respectively.…”

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confidence: 99%

“…Hamoen and colleagues found that, in a subset of 111 men on AS who underwent serial mpMRIs and MRI-guided biopsies, systematic TRUS biopsy identified a considerable proportion of patients who had a Gleason upgrade to 3+4 (from 3+3) at one year(44). Thurtle and colleagues assessed men at baseline and follow up with MRI and biopsy, and concluded that at their centre, follow up protocol biopsies identified additional men with Gleason Group 2 or T3 disease compared to mpMRI and targeted biopsy alone(45). However, they only used 2 cores per target, which may have reduced the reliability of the mpMRI-targeted approach.…”

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confidence: 99%

MRI in active surveillance: a critical review

Stavrinides

Giganti

Emberton

et al. 2018

Prostate Cancer Prostatic Dis

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Progression and treatment rates using an active surveillance protocol incorporating image guided baseline biopsies and multi-parametric MRI monitoring for men with favourable risk prostate cancer

Cited by 7 publications

References 0 publications

Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study

Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study

Comparison of Prostate Biopsy with or without Prebiopsy Multiparametric Magnetic Resonance Imaging for Prostate Cancer Detection: An Observational Cohort Study

MRI in active surveillance: a critical review

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