TY  - INPR
KW  - Active surveillance
KW  -  Magnetic resonance imaging
KW  -  Prostate cancer
TI  - Five-year Outcomes of Magnetic Resonance Imaging-based Active Surveillance for Prostate Cancer: A Large Cohort Study
UR  - http://doi.org/10.1016/j.eururo.2020.03.035
A1  - Stavrinides, V
A1  - Giganti, F
A1  - Trock, B
A1  - Punwani, S
A1  - Allen, C
A1  - Kirkham, A
A1  - Freeman, A
A1  - Haider, A
A1  - Ball, R
A1  - McCartan, N
A1  - Whitaker, H
A1  - Orczyk, C
A1  - Emberton, M
A1  - Moore, CM
Y1  - 2020/04/30/
N2  - 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.
JF  - European Urology
AV  - public
ID  - discovery10097048
SN  - 0302-2838
N1  - © 2020 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article
under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
ER  -