Use of mpMRI in active surveillance for localized prostate cancer

Scarpato, Kristen R.; Barocas, Daniel A.

doi:10.1016/j.urolonc.2016.02.020

Cited by 12 publications

(4 citation statements)

References 54 publications

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“…MRI-guided biopsy more accurately characterizes whole-organ pathology than conventional US-guided biopsy 7–9 . In previous studies, we and others have found that MRI-guided biopsy including target and template samples 10 , helps to detect clinically significant disease (csCaP) in men being screened for AS 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate Cancer

et al. 2017

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Purpose To determine rate of upgrading to Gleason score (GS) ≥ 4+3, using targeted biopsy for diagnosis and monitoring, in men undergoing active surveillance (AS) of prostate cancer (CaP). Materials and Methods Subjects were all 259 men (196 with GS 3+3 and 63 with GS 3+4) who were diagnosed by MRI/US fusion-guided biopsy (2009–2015) and who underwent subsequent fusion biopsy for as long as 4 years of AS. Primary endpoint was discovery of GS ≥ 4+3 CaP. Follow-up biopsies included targeting of positive sites, which were tracked in an Artemis device. Kaplan-Meier curves were generated to determine rates of upgrading, stratified by initial GS and PSA density. Results Based on a Cox proportional hazard model, men with GS 3+4 were 4.65 more likely to have upgrading than men with initial GS 3+3 (3yr, p < 0.01). 63% of men with GS 3+4 had upgraded by the third surveillance year, compared with 18.0% of men starting with GS 3+3 (p < 0.01). 97% of all upgrades (32/33) occurred within an MRI-visible or a tracked site of tumor, rather than a previously-negative systematic site. Independent predictors of upgrading were GS 3+4, PSA density ≥ 0.15 ng/ml/cm3, and a grade 5 lesion on MRI. The incidence-rate ratio of upgrading (GS 3+4 vs. GS 3+3) was 4.25 per year of patient follow-up (p < 0.01). Conclusions During AS of CaP, targeting of tracked tumor foci by MRI/US fusion biopsy allows heightened detection of GS ≥ 4+3 cancers. Baseline variables directly related to important upgrading and warranting increased vigilance include GS 3+4, PSA density ≥ 0.15, and grade 5 lesions on MRI.

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Section: Introductionmentioning

confidence: 99%

Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate Cancer

et al. 2017

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“…Han et al showed that using ultrasound alone, even skilled and experienced urologists are often unable to match their planned core location to the actual site to be sampled within the prostate (14). With the advent of image-fusion devices, recording and later resampling of specific sites containing tumor foci became possible (5,15,16). Some tumors are found outside of MRI-visible lesions or ROIs (12); they can still be tracked.…”

Section: Discussionmentioning

confidence: 99%

Value of Tracking Biopsy in Men Undergoing Active Surveillance of Prostate Cancer

et al. 2018

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“…Multiparametric MRI (mpMRI) is established in the UK as a useful tool to aid prostate cancer diagnosis, and it is recommended in the 2014 NICE guidelines for the assessment of men, both early in surveillance, and during follow‐up . The exact role of mpMRI in AS is under discussion, including the possibility that it can be used to avoid repeat biopsies in some men . Trials with long‐term follow‐up incorporating mpMRI within AS protocols, such as the SPCG17: Prostate Cancer Active Surveillance Trigger Trial (clinicaltrials.gov identifier NCT02914873), are ongoing.…”

Section: Introductionmentioning

confidence: 99%

Best practice in active surveillance for men with prostate cancer: a Prostate Cancer UK consensus statement

et al. 2019

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Objectives To develop a consensus statement on current best practice of active surveillance (AS) in the UK, informed by patients and clinical experts. Subjects and Methods A consensus statement was drafted on the basis of three sources of data: systematic literature search of national and international guidelines; data arising from a Freedom of Information Act request to UK urology departments regarding their current practice of AS; and survey and interview responses from men with localized prostate cancer regarding their experiences and views of AS. The Prostate Cancer UK Expert Reference Group (ERG) on AS was then convened to discuss and refine the statement. Results Guidelines and protocols for AS varied significantly in terms of risk stratification, criteria for offering AS, and protocols for AS between and within countries. Patients and healthcare professionals identified clinical, emotional and process needs for AS to be effective. Men with prostate cancer wanted more information and psychological support at the time of discussing AS with the treating team and in the first 2 years of AS, and a named healthcare professional to discuss any questions or concerns they had. The ERG agreed 30 consensus statements regarding best practice for AS. Statements were grouped under headings: ‘Inclusion/Exclusion Criteria’; ‘AS follow‐up protocol’ and ‘When to stop AS’. Conclusion Significant variation currently exists in the practice of AS in the UK and internationally. Men have clear views on the level of involvement in treatment decisions and support from their treating professionals when receiving AS. The Prostate Cancer UK AS ERG has developed a set of consensus statements for best practice in AS. Evidence for best practice in AS, and the use of multiparametric magnetic resonance imaging in AS, is still evolving, and further studies are needed to determine how to optimize AS outcomes.

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Use of mpMRI in active surveillance for localized prostate cancer

Cited by 12 publications

References 54 publications

Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate Cancer

Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate Cancer

Value of Tracking Biopsy in Men Undergoing Active Surveillance of Prostate Cancer

Best practice in active surveillance for men with prostate cancer: a Prostate Cancer UK consensus statement

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