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Open Access 01-03-2021 | Prostate Cancer | Urogenital

Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort

Authors: Francesco Giganti, Armando Stabile, Vasilis Stavrinides, Elizabeth Osinibi, Adam Retter, Clément Orczyk, Valeria Panebianco, Bruce J. Trock, Alex Freeman, Aiman Haider, Shonit Punwani, Clare Allen, Alex Kirkham, Mark Emberton, Caroline M. Moore

Published in: European Radiology | Issue 3/2021

Abstract

Objectives

The PRECISE recommendations for magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer (PCa) include repeated measurement of each lesion, and attribution of a PRECISE radiological progression score for the likelihood of clinically significant change over time. We aimed to compare the PRECISE score with clinical progression in patients who are managed using an MRI-led AS protocol.

Methods

A total of 553 patients on AS for low- and intermediate-risk PCa (up to Gleason score 3 + 4) who had two or more MRI scans performed between December 2005 and January 2020 were included. Overall, 2161 scans were retrospectively re-reported by a dedicated radiologist to give a PI-RADS v2 score for each scan and assess the PRECISE score for each follow-up scan. Clinical progression was defined by histological progression to ≥ Gleason score 4 + 3 (Gleason Grade Group 3) and/or initiation of active treatment. Progression-free survival was assessed using Kaplan-Meier curves and log-rank test was used to assess differences between curves.

Results

Overall, 165/553 (30%) patients experienced the primary outcome of clinical progression (median follow-up, 74.5 months; interquartile ranges, 53–98). Of all patients, 313/553 (57%) did not show radiological progression on MRI (PRECISE 1–3), of which 296/313 (95%) had also no clinical progression. Of the remaining 240/553 patients (43%) with radiological progression on MRI (PRECISE 4–5), 146/240 (61%) experienced clinical progression (p < 0.0001). Patients with radiological progression on MRI (PRECISE 4-5) showed a trend to an increase in PSA density.

Conclusions

Patients without radiological progression on MRI (PRECISE 1-3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy.

Key Points

• Patients without radiological progression on MRI (PRECISE 1–3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy.

• Clinical progression was almost always detectable in patients with radiological progression on MRI (PRECISE 4–5) during AS.

• Patients with radiological progression on MRI (PRECISE 4–5) during AS showed a trend to an increase in PSA density.

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Title: Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort
Authors: Francesco Giganti
Armando Stabile
Vasilis Stavrinides
Elizabeth Osinibi
Adam Retter
Clément Orczyk
Valeria Panebianco
Bruce J. Trock
Alex Freeman
Aiman Haider
Shonit Punwani
Clare Allen
Alex Kirkham
Mark Emberton
Caroline M. Moore
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Prostate Cancer
Published in: European Radiology / Issue 3/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07256-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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