Randomized Study of Systematic Biopsy Versus Magnetic Resonance Imaging and Targeted and Systematic Biopsy in Men on Active Surveillance (ASIST): 2-year Postbiopsy Follow-up

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

doi:10.1016/j.eururo.2019.10.007

Cited by 116 publications

(92 citation statements)

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“…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: 94%

“…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%

“…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]. In light of varied results from prior studies, we sought to evaluate our own institutional experience of whether the contemporary use of mpMRI has improved the identification of occult higher-grade PCa amongst men enrolled on AS compared to a pre-mpMRI era where only systematic biopsies were used.…”

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: 94%

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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“…TRUS was performed after TPM, and this might contribute to the poor accuracy of TRUS. Since each test was blind, they could not evaluate the utility of MRI targeted prostate biopsies [ 58 ].…”

Section: Imagistic Techniquesmentioning

confidence: 99%

PSA Based Biomarkers, Imagistic Techniques and Combined Tests for a Better Diagnostic of Localized Prostate Cancer

Munteanu

Gulei

et al. 2020

Diagnostics

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Prostate cancer represents the most encountered urinary malignancy in males over 50 years old, and the second most diagnosed after lung cancer globally. Digital rectal examination and prostatic specific antigen were the long-time standard tools for diagnosis but with a significant risk of overdiagnosis and overtreatment. Magnetic resonance imaging recently entered the diagnosis process, but to this date, there is no specific biomarker that accurately indicates whether to proceed with the prostate biopsy. Research in this area has gone towards this direction, and recently, serum, urine, imagistic, tissue biomarkers, and Risk Calculators promise to help better diagnose and stratify prostate cancer. In order to eliminate the comorbidities that appear along with the diagnosis and treatment of this disease, there is a constant need to implement new diagnostic strategies. Important uro-oncology associations recommend the use of novel biomarkers in the grey area of prostate cancer, to better distinguish the next step in the diagnostic process. Although it is not that simple, they should be integrated according to the clinical policies, and it should be considered that statistical significance does not always equal clinical significance. In this review, we analyzed the contribution of prostate-specific antigen (PSA)-based biomarkers (PHI, PHID, 4Kscore, STHLM3), imagistic techniques (mp-MRI and mp-US), and combined tests in the early diagnosis process of localized prostate cancer.

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“…MRI targeted biopsy (MRtb) has a proven utility in several clinical scenarios, such as in patients with prior negative transrectal ultrasound (TRUS)-guided prostate biopsy and in the monitoring of patients under active surveillance (AS) [2, 3]. Especially lesions in areas that are mostly undersampled with TRUS biopsy (e.g., midline, anterior, and distal apical) can be thoroughly assessed by mpMRI and MRtb.…”

Section: Introductionmentioning

confidence: 99%

Current Role of Multiparametric MRI and MRI Targeted Biopsies for Prostate Cancer Diagnosis in Germany: A Nationwide Survey

et al. 2020

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Introduction: Multiparametric MRI (mpMRI) and MRI targeted biopsies (MRtb) are a new standard in prostate cancer (PCa) screening and diagnosis. Guidelines already include this approach for patients at risk. We aimed to gather information from German urologists about their knowledge, routine use, and attitude toward mpMRI and consecutive biopsy methods. Materials and Methods: An anonymous online questionnaire was sent via Survey Monkey to the members of the German Society of Urology (DGU). Statistical analyses were performed using SPSS version 25.0. Results: 496 members with a median age of 48.6 years (±11.7) participated in the survey. The majority rated mpMRI of the prostate as a very useful diagnostic tool (72.7%). MRtb of the prostate was considered as very advantageous (71.5%). MpMRI was used by 95.9%, and 83.2% also recommended MRtb predominantly in clinical institutions. For targeted biopsy, MRI-ultrasound fusion biopsy was clearly favored (75.8%). MpMRI was mostly used in patients with previously negative biopsy (90.9%) and in patients under active surveillance (60.9%). Arguments against the use of prostate mpMRI are costs (84.9%) and/or lack of sufficient radiological infrastructure (17.4%). Conclusion: Our data illustrate the meanwhile high acceptance and clinical use of the prostate mpMRI and MRtb in Germany.

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Randomized Study of Systematic Biopsy Versus Magnetic Resonance Imaging and Targeted and Systematic Biopsy in Men on Active Surveillance (ASIST): 2-year Postbiopsy Follow-up

Cited by 116 publications

References 14 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

PSA Based Biomarkers, Imagistic Techniques and Combined Tests for a Better Diagnostic of Localized Prostate Cancer

Current Role of Multiparametric MRI and MRI Targeted Biopsies for Prostate Cancer Diagnosis in Germany: A Nationwide Survey

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