gms | German Medical Science

69. Kongress der Nordrhein-Westfälischen Gesellschaft für Urologie

Nordrhein-Westfälische Gesellschaft für Urologie e. V.

11.04. - 12.04.2024, Essen

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MRI-guided active surveillance in patients with ISUP 1 and 2 prostate cancer – results of radical prostatectomy and follow up of the PROMM-AS study

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  • presenting/speaker Jan Philipp Radtke - Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf, Deutschland; Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg, Deutschland
  • R. Al-Monajjed - Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf, Deutschland
  • C. Arsov - Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf, Deutschland
  • B. Valentin - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • T. Ullrich - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • M. Boschheidgen - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • Boris Hadaschik - Universitätsklinikum Essen, Klinik für Urologie, Essen, Deutschland
  • F. Giganti - University College London Hospitals NHS Foundation Trust, Department of Radiology, London, UK
  • M. Gießing - Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf, Deutschland
  • C. Lopez-Cotarelo - Universitätsklinikum Düsseldorf, Institut für Pathologie, Düsseldorf, Deutschland
  • T. Rau - Universitätsklinikum Düsseldorf, Institut für Pathologie, Düsseldorf, Deutschland
  • I. Esposito - Universitätsklinikum Düsseldorf, Institut für Pathologie, Düsseldorf, Deutschland
  • G. Antoch - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • L. Schimmöller - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • Peter Albers - Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf, Deutschland

Nordrhein-Westfälische Gesellschaft für Urologie. 69. Kongress der Nordrhein-Westfälischen Gesellschaft für Urologie. Essen, 11.-12.04.2024. Düsseldorf: German Medical Science GMS Publishing House; 2024. DocV 1.4

doi: 10.3205/24nrwgu04, urn:nbn:de:0183-24nrwgu042

Published: March 26, 2024

© 2024 Radtke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: Multiparametric magnetic resonance imaging (mpMRI) avoids repeat prostate biopsies in the monitoring of patients with prostate cancer (PC) undergoing active surveillance (AS). We already published results of the prospective PROMM-AS trial confirming the reduction of biopsies and reliable prediction of upgrading in patients with ISUP GG1 and GG2 PC. Within this study, fusion-biopsies were only performed in cases of mpMRI progression (PRECISE 4–5) at 12 months and/or at the end of the study in cases of stable mpMRIs. Here we present data of the radical prostatectomy (RP) specimens and mid-term follow up data in men who discontinued AS due to histopathological progression or on their own request.

Methods: Primary endpoint was occurrence of unfavourable disease at RP specimen, secondary endpoints were i) PSA at 12 months, ii) PSA relapse and iii) development of metastases. We also performed regression analyses including MRI and clinical variables for PSA relapse.

Results: Overall, 31 (21%) out of 150 men (18 ISUP GG1 and 13 ISUP GG2) experienced histopathological progression (N=18) or discontinued AS and underwent subsequent RP (N=5). The remainders were treated with radiotherapy or other treatments.

Unfavourable disease (pT3) occurred in n=4 (17%) of patients, n=3 (27%) in the initial ISUP GG1 and n=1 (8%) in the ISUP GG2 subgroup. One patient in the ISUP GG1 (9%) and two men (17%) in the ISUP GG2 subgroup had ISUP3 PC at RP. Distribution of ISUP and pT is given in the table below [Tab. 1]. Median follow up was 18 months. Among all men with RP 95% had PSA level <0.01 ng/mL 12 months after RP. Only one man (5%) showed PSA relapse. No metastases occurred in the mid-term follow-up. Neither initial ISUP, nor MRI or other clinical parameters were significant predictors of the analysed end points.

Conclusions: This evaluation of RP specimen and mid-term follow up of the prospective MRI-guided monitoring of patients on AS (PROMM-AS) study demonstrated that AS is oncological safe in patients with ISUP GG1 or GG2 PC. Unfavourable disease was observed in only 17%, not significantly related to ISUP GG2 subgroup. At mid-term follow-up no excess biochemical recurrence rates were observed. Mature data will show if MRI-guided AS without biopsies even in ISUP GG2 PC is a feasible approach.