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Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] ()

BACKGROUND: Although the use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) for prostate cancer is of increasing interest, existing data are derived from small cohorts. OBJECTIVE: We describe clinical, histological, and radiological outcomes from an established AS...

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Autores principales: Stavrinides, Vasilis, Giganti, Francesco, Trock, Bruce, Punwani, Shonit, Allen, Clare, Kirkham, Alex, Freeman, Alex, Haider, Aiman, Ball, Rhys, McCartan, Neil, Whitaker, Hayley, Orczyk, Clement, Emberton, Mark, Moore, Caroline M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443696/
https://www.ncbi.nlm.nih.gov/pubmed/32360049
http://dx.doi.org/10.1016/j.eururo.2020.03.035
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author Stavrinides, Vasilis
Giganti, Francesco
Trock, Bruce
Punwani, Shonit
Allen, Clare
Kirkham, Alex
Freeman, Alex
Haider, Aiman
Ball, Rhys
McCartan, Neil
Whitaker, Hayley
Orczyk, Clement
Emberton, Mark
Moore, Caroline M.
author_facet Stavrinides, Vasilis
Giganti, Francesco
Trock, Bruce
Punwani, Shonit
Allen, Clare
Kirkham, Alex
Freeman, Alex
Haider, Aiman
Ball, Rhys
McCartan, Neil
Whitaker, Hayley
Orczyk, Clement
Emberton, Mark
Moore, Caroline M.
author_sort Stavrinides, Vasilis
collection PubMed
description BACKGROUND: Although the use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) for prostate cancer is of increasing interest, existing data are derived from small cohorts. OBJECTIVE: We describe clinical, histological, and radiological outcomes from an established AS programme, where protocol-based biopsies were omitted in favour of MRI-led monitoring. DESIGN, SETTING, AND PARTICIPANTS: Data on 672 men enrolled in AS between August 2004 and November 2017 (inclusion criteria: Gleason 3 + 3 or 3 + 4 localised prostate cancer, presenting prostate-specific antigen <20 ng/ml, and baseline mpMRI) were collected from the University College London Hospital (UCLH) database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcomes were event-free survival (EFS; event defined as prostate cancer treatment, transition to watchful waiting, or death) and treatment-free survival (TFS). Secondary outcomes included rates of all-cause or prostate cancer–related mortality, metastasis, and upgrading to Gleason ≥4 + 3. Data on radiological and histological progression were also collected. RESULTS AND LIMITATIONS: More than 3800 person-years (py) of follow-up were accrued (median: 58 mo; interquartile range 37–82 mo). Approximately 84.7% (95% confidence interval [CI]: 82.0–87.6) and 71.8% (95% CI: 68.2–75.6) of patients remained on AS at 3 and 5 yr, respectively. EFS and TFS were lower in those with MRI-visible (Likert 4–5) disease or secondary Gleason pattern 4 at baseline (log-rank test; p <  0.001). In total, 216 men were treated. There were 24 deaths, none of which was prostate cancer related (6.3/1000 py; 95% CI: 4.1–9.5). Metastases developed in eight men (2.1 events/1000 py; 95% CI: 1.0–4.3), whereas 27 men upgraded to Gleason ≥4 + 3 on follow-up biopsy (7.7 events/1000 py; 95% CI: 5.2–11.3). CONCLUSIONS: The rates of discontinuation, mortality, and metastasis in MRI-led surveillance are comparable with those of standard AS. MRI-visible disease and/or secondary Gleason grade 4 at baseline are associated with a greater likelihood of moving to active treatment at 5 yr. Further research will concentrate on optimising imaging intervals according to baseline risk. PATIENT SUMMARY: In this report, we looked at the outcomes of magnetic resonance imaging (MRI)-based surveillance for prostate cancer in a UK cohort. We found that this strategy could allow routine biopsies to be avoided. Secondary Gleason pattern 4 and MRI visibility are associated with increased rates of treatment. We conclude that MRI-based surveillance should be considered for the monitoring of small prostate tumours.
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spelling pubmed-74436962020-09-01 Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] () Stavrinides, Vasilis Giganti, Francesco Trock, Bruce Punwani, Shonit Allen, Clare Kirkham, Alex Freeman, Alex Haider, Aiman Ball, Rhys McCartan, Neil Whitaker, Hayley Orczyk, Clement Emberton, Mark Moore, Caroline M. Eur Urol Article BACKGROUND: Although the use of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) for prostate cancer is of increasing interest, existing data are derived from small cohorts. OBJECTIVE: We describe clinical, histological, and radiological outcomes from an established AS programme, where protocol-based biopsies were omitted in favour of MRI-led monitoring. DESIGN, SETTING, AND PARTICIPANTS: Data on 672 men enrolled in AS between August 2004 and November 2017 (inclusion criteria: Gleason 3 + 3 or 3 + 4 localised prostate cancer, presenting prostate-specific antigen <20 ng/ml, and baseline mpMRI) were collected from the University College London Hospital (UCLH) database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcomes were event-free survival (EFS; event defined as prostate cancer treatment, transition to watchful waiting, or death) and treatment-free survival (TFS). Secondary outcomes included rates of all-cause or prostate cancer–related mortality, metastasis, and upgrading to Gleason ≥4 + 3. Data on radiological and histological progression were also collected. RESULTS AND LIMITATIONS: More than 3800 person-years (py) of follow-up were accrued (median: 58 mo; interquartile range 37–82 mo). Approximately 84.7% (95% confidence interval [CI]: 82.0–87.6) and 71.8% (95% CI: 68.2–75.6) of patients remained on AS at 3 and 5 yr, respectively. EFS and TFS were lower in those with MRI-visible (Likert 4–5) disease or secondary Gleason pattern 4 at baseline (log-rank test; p <  0.001). In total, 216 men were treated. There were 24 deaths, none of which was prostate cancer related (6.3/1000 py; 95% CI: 4.1–9.5). Metastases developed in eight men (2.1 events/1000 py; 95% CI: 1.0–4.3), whereas 27 men upgraded to Gleason ≥4 + 3 on follow-up biopsy (7.7 events/1000 py; 95% CI: 5.2–11.3). CONCLUSIONS: The rates of discontinuation, mortality, and metastasis in MRI-led surveillance are comparable with those of standard AS. MRI-visible disease and/or secondary Gleason grade 4 at baseline are associated with a greater likelihood of moving to active treatment at 5 yr. Further research will concentrate on optimising imaging intervals according to baseline risk. PATIENT SUMMARY: In this report, we looked at the outcomes of magnetic resonance imaging (MRI)-based surveillance for prostate cancer in a UK cohort. We found that this strategy could allow routine biopsies to be avoided. Secondary Gleason pattern 4 and MRI visibility are associated with increased rates of treatment. We conclude that MRI-based surveillance should be considered for the monitoring of small prostate tumours. Elsevier Science 2020-09 /pmc/articles/PMC7443696/ /pubmed/32360049 http://dx.doi.org/10.1016/j.eururo.2020.03.035 Text en © 2020 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Stavrinides, Vasilis
Giganti, Francesco
Trock, Bruce
Punwani, Shonit
Allen, Clare
Kirkham, Alex
Freeman, Alex
Haider, Aiman
Ball, Rhys
McCartan, Neil
Whitaker, Hayley
Orczyk, Clement
Emberton, Mark
Moore, Caroline M.
Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] ()
title Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] ()
title_full Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] ()
title_fullStr Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] ()
title_full_unstemmed Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] ()
title_short Five-year Outcomes of Magnetic Resonance Imaging–based Active Surveillance for Prostate Cancer: A Large Cohort Study [Image: see text] ()
title_sort five-year outcomes of magnetic resonance imaging–based active surveillance for prostate cancer: a large cohort study [image: see text] ()
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443696/
https://www.ncbi.nlm.nih.gov/pubmed/32360049
http://dx.doi.org/10.1016/j.eururo.2020.03.035
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