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The Role of Multiparametric MRI in Patients on Active Surveillance for Prostate Cancer: Assessment and Validation of the Precise Recommendations

Giganti, Francesco; (2021) The Role of Multiparametric MRI in Patients on Active Surveillance for Prostate Cancer: Assessment and Validation of the Precise Recommendations. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Introduction: Magnetic resonance imaging (MRI) of the prostate can identify candidates for active surveillance (AS), who can safely be monitored to allow prompt curative treatment if the disease shows signs of becoming more aggressive. Methods: We established the guidelines for the reporting of MRI in AS, known as the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations. The key features are the measurement of each lesion at every time point, and a determination of the likelihood of radiological progression according to changes in tumour size and conspicuity using a 1-to-5 scale (PRECISE score). I evaluated the impact of Dutasteride on tumour conspicuity on MRI. I applied the PRECISE score at University College London Hospital (UCLH) and analysed the inter-observer variability at two different centres. As prostate MRI quality is key during AS, I created a new scoring system (PI-QUAL) to assess image quality. Results: Dutasteride affects tumour conspicuity on diffusion-weighted imaging. Freedom from clinical progression (i.e., progression to ≥ Gleason Grade Group 3 or initiation of active treatment) at 60 months in the UCLH cohort is 97% for PRECISE 1-2 (radiological regression) and PRECISE 3 (radiological stability), while only 61%, for PRECISE 4-5 (radiological progression) (p<0.001). There is a significant difference in the average yearly percentage volume change over time stratified by PRECISE score using the ellipsoid formula. The inter-reader reproducibility of PRECISE is substantial (κ = 0.71 and agreement = 79%). PI-QUAL is a promising scoring system (1-to-5 Likert scale) to assess the diagnostic quality of MRI. Conclusions: Patients without radiological progression (PRECISE 1-3) during AS have a very low likelihood of clinical progression and many could avoid routine re-biopsy. The inter-reader agreement of PRECISE is substantial. PI-QUAL represents the start of identifying a framework for the assessment of prostate MR quality.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The Role of Multiparametric MRI in Patients on Active Surveillance for Prostate Cancer: Assessment and Validation of the Precise Recommendations
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: https://discovery.ucl.ac.uk/id/eprint/10129642
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