Value of Serial Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Imaging–guided Biopsies in Men with Low-risk Prostate Cancer on Active Surveillance After 1 Yr Follow-up

Hamoen, E.H.J.; Hoeks, Caroline; Somford, Diederik M.; Oort, Inge M. van; Vergunst, H.; Oddens, Jorg R.; Smits, G.A.H.J.; Bokhorst, Leonard P.; Witjes, J. Alfred; Rovers, Maroeska M.; Kaa, Christina A. Hulsbergen‐van de; Barentsz, Jelle O.

doi:10.1016/j.euf.2017.12.008

Cited by 27 publications

(40 citation statements)

References 31 publications

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“…Similarly, Shaw et al reported superiority of targeted biopsies (TB) over standard TRUS-biopsies [12]. Recent studies emphasize the benefit of additional MRI and MRI-guided biopsy for AS [7,13,14]. In a previously published AS-cohort with a two-year follow-up, our group demonstrated a significantly decreased AS disqualification with initial MRI/TRUS-fusion biopsy, compared to initial 12-core-TRUS-biopsy [7].…”

Section: Introductionsupporting

confidence: 53%

Standardized Magnetic Resonance Imaging Reporting Using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Criteria and Magnetic Resonance Imaging/Transrectal Ultrasound Fusion with Transperineal Saturation Biopsy to Select Men on Active Surveillance

Dieffenbacher

Nyarangi‐Dix

Giganti

et al. 2021

European Urology Focus

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Background: Contemporary selection criteria for men with prostate cancer (PC) suitable for active surveillance (AS) are unsatisfactory, leading to high disqualification rates based on tumour misclassification. Conventional biopsy protocols are based on standard 12-core-TRUS-biopsy. Objective: We assessed the value of MRI-/TRUS-fusion-biopsy over a 4-year followup in men on AS for low-risk PC. Design, Setting and Participants: Between 2010 and 2018, a total of 273 men were included. 157 men with initial 12-core-TRUS-biopsy and 116 men with initial MRI-/TRUS-fusion-biopsy were followed by systematic and targeted transperineal MRI-/TRUS-fusion-biopsies based on PRIAS-criteria. MR-imaging from follow-up MRI/TRUS-fusion-biopsy was assessed using the PRECISE-scoring system. Outcome measurements and statistical analysis: AS-disqualification rates for patients on AS initially diagnosed by either 12-core TRUS biopsy or MRI/TRUS-fusion-biopsy were compared using Kaplan-Meier estimates, log-rank tests and regression analyses. We also analyzed the influence of a negative primary MRI and PRECISE-scoring to predict AS-disqualification using Kaplan-Meier estimates, log-rank tests and receiver operating characteristics (ROC) curve analysis. Results and limitations: 59% of men diagnosed by 12-core-TRUS-biopsy were disqualified from AS based on results of subsequent MRI/TRUS-fusion-biopsy. In the initial MRI-fusion-biopsy cohort, upgrading occurred significantly less frequently (19%, p<0.001). ROC-curve analyses demonstrated a good discrimination for the PRECISE-score with an Area under the curve (AUC) of 0.83. No men with a PRECISE-score of 1 or 2 (demonstrating absence or downgrading of lesions in follow-up MRI) were disqualified from AS. In our cohort, a negative baseline MR scan

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Section: Introductionsupporting

confidence: 53%

Standardized Magnetic Resonance Imaging Reporting Using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Criteria and Magnetic Resonance Imaging/Transrectal Ultrasound Fusion with Transperineal Saturation Biopsy to Select Men on Active Surveillance

Dieffenbacher

Nyarangi‐Dix

Giganti

et al. 2021

European Urology Focus

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“…(B) Applying the stratification in an external cohort from Spain (n = 179) using the progression classifiers showed similar stratified rates of progression it might have specific value when the PSAD is low. Other studies have shown the value of adding mpMRI to guide repeat biopsies and improve Grade reclassification, although its role in monitoring remains keenly debated [32,[35][36][37]. Clearly though, using mpMRI as part of AS seems logical and a guide to trigger repeat biopsies, although not necessarily a change in management [13].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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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%

MRI in active surveillance: a critical review

Stavrinides

Giganti

Emberton

et al. 2018

Prostate Cancer Prostatic Dis

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Value of Serial Multiparametric Magnetic Resonance Imaging and Magnetic Resonance Imaging–guided Biopsies in Men with Low-risk Prostate Cancer on Active Surveillance After 1 Yr Follow-up

Cited by 27 publications

References 31 publications

Standardized Magnetic Resonance Imaging Reporting Using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Criteria and Magnetic Resonance Imaging/Transrectal Ultrasound Fusion with Transperineal Saturation Biopsy to Select Men on Active Surveillance

Standardized Magnetic Resonance Imaging Reporting Using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Criteria and Magnetic Resonance Imaging/Transrectal Ultrasound Fusion with Transperineal Saturation Biopsy to Select Men on Active Surveillance

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

MRI in active surveillance: a critical review

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