Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer

Alberts, Arnout R.; Roobol, Monique J.; Drost, Frank-Jan H.; Leenders, Geert J.L.H. van; Bokhorst, Leonard P.; Bangma, Chris H.; Schoots, Ivo G.

doi:10.1111/bju.13836

Cited by 73 publications

(68 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is no longer the case when MRI risk stratification is taken into account. Other studies have shown that ~10% of men on active surveillance with no visible MRI lesion will be found to have upgrading if routine confirmatory biopsies are performed . In the present study, only 1.8% of patients with negative MRI were found to have upgrading on confirmatory biopsy.…”

Section: Discussioncontrasting

confidence: 66%

Four‐year outcomes from a multiparametric magnetic resonance imaging (MRI)‐based active surveillance programme: PSA dynamics and serial MRI scans allow omission of protocol biopsies

et al. 2018

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 66%

Four‐year outcomes from a multiparametric magnetic resonance imaging (MRI)‐based active surveillance programme: PSA dynamics and serial MRI scans allow omission of protocol biopsies

et al. 2018

View full text Add to dashboard Cite

show abstract

“…PSAD has been well reported to be a marker of progression in AS . Remarkably the threshold value of 0.15 ng/mL/mL has been found independently in many of these studies . In our present analysis, the presence of a baseline MRI lesion was not predictive of progression and we had too few cases to sub‐analyse differences between Likert 3, 4 and 5 lesions.…”

Section: Discussionmentioning

confidence: 51%

“…However, strikingly, many men with CPG2 disease (32/37 in the UK series, >85%) actually did not progress. PSAD has been well reported to be a marker of progression in AS . Remarkably the threshold value of 0.15 ng/mL/mL has been found independently in many of these studies .…”

Section: Discussionmentioning

confidence: 82%

Using prognosis to guide inclusion criteria, define standardised endpoints and stratify follow‐up in active surveillance for prostate cancer

et al. 2019

View full text Add to dashboard Cite

Objectives To test whether using disease prognosis can inform a rational approach to active surveillance (AS) for early prostate cancer. Patients and methods We previously developed the Cambridge Prognostics Groups (CPG) classification, a five‐tiered model that uses prostate‐specific antigen (PSA), Grade Group and Stage to predict cancer survival outcomes. We applied the CPG model to a UK and a Swedish prostate cancer cohort to test differences in prostate cancer mortality (PCM) in men managed conservatively or by upfront treatment in CPG2 and 3 (which subdivides the intermediate‐risk classification) vs CPG1 (low‐risk). We then applied the CPG model to a contemporary UK AS cohort, which was optimally characterised at baseline for disease burden, to identify predictors of true prognostic progression. Results were re‐tested in an external AS cohort from Spain. Results In a UK cohort (n = 3659) the 10‐year PCM was 2.3% in CPG1, 1.5%/3.5% in treated/untreated CPG2, and 1.9%/8.6% in treated/untreated CPG3. In the Swedish cohort (n = 27 942) the10‐year PCM was 1.0% in CPG1, 2.2%/2.7% in treated/untreated CPG2, and 6.1%/12.5% in treated/untreated CPG3. We then tested using progression to CPG3 as a hard endpoint in a modern AS cohort (n = 133). During follow‐up (median 3.5 years) only 6% (eight of 133) progressed to CPG3. Predictors of progression were a PSA density ≥0.15 ng/mL/mL and CPG2 at diagnosis. Progression occurred in 1%, 8% and 21% of men with neither factor, only one, or both, respectively. In an independent Spanish AS cohort (n = 143) the corresponding rates were 3%, 10% and 14%, respectively. Conclusion Using disease prognosis allows a rational approach to inclusion criteria, discontinuation triggers and risk‐stratified management in AS.

show abstract

“…In our study population, this would have resulted in a 20% decrease in the number of biopsies performed, and only 4% of significant cancers would have escaped diagnosis. If slightly different criteria suggested by other authors were applied to our cohort (i.e., PIRADS = 3 and PSAD < 0.15) [14,16,17], it would result in a 50% reduction in the number of biopsies but would also miss 21% of significant cancers. We speculate that the discrepancy between this finding and those reported in other papers might be explained by the performance of the mpMRI [3,18,19].…”

Section: Discussionmentioning

confidence: 99%

Use of Prostate Specific Antigen Density Combined with Multiparametric Magnetic Resonance Imaging Improves Triage for Prostate Biopsy

et al. 2019

View full text Add to dashboard Cite

Background: Multi-parametric magnetic resonance imaging (mpMRI)-directed biopsy for prostate cancer (PC) diagnosis improves the detection of clinically significant prostate cancer (CSPC) and decreases the rate of over-diagnosis of insignificant disease. The aim of this study was to investigate the value of mpMRI combined with prostate specific antigen density (PSAD) in the decision making related to the biopsy. Methods: mpMRI and mpMRI/transrectal ultrasound fusion targeted biopsies with subsequent systematic biopsies were performed in 397 patients (223 biopsy-naïve and 174 with a previous biopsy). Detection rates of (CSPC) and insignificant PC were stratified using the PIRADS score, and the number of avoidable biopsies and missed (CSPC) were plotted against PSAD values of 0.1–0.5 ng/mL². Results: PIRADS <3 and PSAD <0.2 ng/mL² were the safest criteria for not performing a biopsy. When applied to the biopsy-naïve group, 21.5% (48/223) of the biopsies could have been avoided and 3.7% (3/82) of CSPC would have been missed. In the repeat biopsy group, 12.6% (22/174) of biopsies could have been avoided and 6.9% (4/58) of (CSPC) would have been missed. Conclusions: A combination of mpMRI and PSAD might reduce the number of biopsies performed with the cost of missing <4% of CSPC.

show abstract

Risk‐stratification based on magnetic resonance imaging and prostate‐specific antigen density may reduce unnecessary follow‐up biopsy procedures in men on active surveillance for low‐risk prostate cancer

Cited by 73 publications

References 39 publications

Four‐year outcomes from a multiparametric magnetic resonance imaging (MRI)‐based active surveillance programme: PSA dynamics and serial MRI scans allow omission of protocol biopsies

Four‐year outcomes from a multiparametric magnetic resonance imaging (MRI)‐based active surveillance programme: PSA dynamics and serial MRI scans allow omission of protocol biopsies

Using prognosis to guide inclusion criteria, define standardised endpoints and stratify follow‐up in active surveillance for prostate cancer

Use of Prostate Specific Antigen Density Combined with Multiparametric Magnetic Resonance Imaging Improves Triage for Prostate Biopsy

Contact Info

Product

Resources

About