Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center

Carlsson, Sigrid; Benfante, Nicole; Alvim, Ricardo; Sjoberg, Daniel D.; Reuter, Victor E.; Fine, Samson W.; Vargas, Hebert Alberto; Wiseman, Michal; Mamoor, Maha; Ehdaie, Behfar; Laudone, Vincent P.; Scardino, Peter T.; Eastham, James A.; Touijer, Karim

doi:10.1097/ju.0000000000000742

Cited by 32 publications

(37 citation statements)

References 20 publications

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“…In addition, our definition of significant PCa (GG ≥ 2) was different from the definition (GG > 2) in previous studies (25). Based on the evidence, our criteria have been extended in terms of the volume of GG 1 and the low volume of GG 2 in older patients (27). However, this change did not affect the results of the present study.…”

Section: Discussionmentioning

confidence: 70%

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Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

et al. 2021

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Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imagingreporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

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Section: Discussionmentioning

confidence: 70%

“…Based on the evidence, our criteria have been extended in terms of the volume of GG 1 and the low volume of GG 2 in older patients ( 27 ). However, this change did not affect the results of the present study.…”

Section: Discussionmentioning

confidence: 99%

Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

et al. 2021

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“…Kaplan-Meier curves active treatment-free survival by diagnostic group (GG1 with PSAD less than 0.15 ng/ml/cm 3 vs GG1 with PSAD 0.15 ng/ml/cm 3 or greater vs GG2 with any PSAD) same group separately analyzed data from men with GG2, and over a median followup of 3.1 years reported 2 cases with lymph node metastases (no men had distant metastases). 19 These series, including the current study, although with different surveillance protocols, selection criteria and underlying clinical risk, demonstrate variable yet favorable long-term outcomes.…”

Section: Discussionmentioning

confidence: 74%

The Long-Term Risks of Metastases in Men on Active Surveillance for Early Stage Prostate Cancer

et al. 2020

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We assessd the long-term outcomes from a large prospective cohort of men diagnosed with prostate cancer managed with active surveillance and determined the clinical prognostic factors that may predict the risk of metastases. Materials and Methods: We retrospectively reviewed data of men enrolled on active surveillance at our institution between 1990 and 2018 with low or intermediate risk disease (stage cT1-2, prostate specific antigen less than 20 ng/ml, and biopsy Grade Group [GG]1-2). Patients were classified into 3 groups by diagnostic GG and prostate specific antigen density. Primary outcome was metastatic prostate cancer detected on imaging or at prostatectomy. In addition, upgrade at surveillance biopsy, active treatment, and overall and prostate cancer specific survival outcomes were assessed. Cox proportional hazards regression models were used. Results: A total of 1,450 men met the inclusion criteria. Median followup was 77 months (IQR 49e114). The 7-year metastasis-free survival rate was 99%. Metastases developed in 15 men at a median of 62 months (IQR 29e104), of which 69% were confined to lymph nodes. Men with GG2 had a lower metastasis-free survival rate compared to those with GG1 disease. GG2, prostate specific antigen velocity and PI-RADSÒ 4-5 lesions on multiparametric magnetic resonance imaging were associated with a higher risk of metastases. The 7-year prostate cancer specific survival was greater than 99%. Conclusions: Active surveillance seems to preserve favorable long-term prognosis, as metastases and prostate cancer specific death are rare. However, the higher risk of metastases associated with higher Gleason grade, prostate specific antigen velocity, and characteristics on multiparametric magnetic resonance imaging should be considered when selecting and counseling patients for active surveillance.

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“…AS involves multiple follow-up prostate-specific antigen (PSA) values, imaging tests, and systematic biopsy, usually every 12-24 mo [5]. Although AS is intended to avoid or delay unnecessary radical treatment, it is not without costs and concerns to patients and their physicians [6,7]. A patient's anxiety about a cancer diagnosis or preference for an aggressive approach in the absence of clinical progression could be a trigger for choosing alternative treatments [8,9].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Cancer Progression on Serial Biopsy in Men on Active Surveillance for Early-stage Prostate Cancer: Implications for Focal Therapy

Fasulo

Cowan

Maggi

et al. 2022

European Urology Oncology

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Background: Active surveillance (AS) is a safe and accepted option for managing men with low-risk prostate cancer. Nevertheless, some patients lack confidence in or access to AS. Focal therapy (FT) is a possible alternative to radical treatment for such patients. Objective: We evaluated dominant tumor (DT) progression across serial biopsies to determine whether men on AS could be reasonable candidates for FT. Design, setting, and participants: Men enrolled in AS at University of California, San Francisco between 1996 and 2017 with low/intermediate risk were included. Outcome measurements and statistical analysis: Changes in biopsy grade, volume, and focality of the DT over time were assessed. Focality (good or poor for FT) was defined by the number of cores, laterality, and contiguity of prostate sites containing tumor (based on pathology reports). Candidates (either for targeted/quadrant ablation or for hemigland ablation) were defined based on good focality, grade group (GG) 2, and low-volume disease. Patients were classified as favorable (GG 2 with good focality and concordant multiparametric magnetic resonance imaging [mpMRI]) or unfavorable (poor focality or high-volume disease or discordant mpMRI) for FT at surveillance biopsies. Results and limitations: A total of 1057 men met the inclusion criteria. The median number of biopsies per patient was three (interquartile range 2-4), and 196 patients (18.5%) underwent five or more biopsies. At confirmatory biopsy, 43% remained candidates for FT (67% for targeted/quadrant ablation and 33% for hemigland ablation) and 20% had a negative biopsy. Of the candidates for FT at initial biopsy, 11% had less favorable characteristics at confirmatory biopsy. Among candidates for FT based on both initial and confirmatory biopsies, 70% remained favorable for hemigland ablation at subsequent biopsies. Limitations include retrospective design and mpMRI information only at surveillance biopsy.

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Risk of Metastasis in Men with Grade Group 2 Prostate Cancer Managed with Active Surveillance at a Tertiary Cancer Center

Cited by 32 publications

References 20 publications

Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

The Long-Term Risks of Metastases in Men on Active Surveillance for Early Stage Prostate Cancer

Characteristics of Cancer Progression on Serial Biopsy in Men on Active Surveillance for Early-stage Prostate Cancer: Implications for Focal Therapy

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