Article
MRI-guided active surveillance in patients with ISUP 1 prostate cancer – a multi-institutional validation of the discrimination of the PRECISE score
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Authors
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Jan Philipp Radtke
- Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf, Deutschland; Deutsches Krebsforschungszentrum, Abteilung Radiologie, Heidelberg, Deutschland
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N. Sushentsev
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Department of Radiology, Cambridge, UK
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M. Wiesenfarth
- Deutsches Krebsforschungszentrum, Abteilung Biostatistik, Heidelberg, Deutschland
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M. Dixius
- Universitätsklinikum Essen, Klinik für Urologie, Essen, Deutschland
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C. Kastner
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Department of Urology, Cambridge, UK
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A. Borkowetz
- Universitätsklinikum Dresden, Klinik für Urologie, Dresden, Deutschland
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C. Thomas
- Universitätsklinikum Dresden, Klinik für Urologie, Dresden, Deutschland
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I. Platzke
- Universitätsklinikum Dresden, Institut für Diagnostische und Interventionelle Radiologie, Dresden, Deutschland
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C. Kesch
- Universitätsklinikum Essen, Klinik für Urologie, Essen, Deutschland
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L. Umutlu
- Universitätsklinikum Essen, Institut für Diagnostische und Interventionelle Radiologie, Essen, Deutschland
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H. Reis
- Universitätsklinikum Frankfurt, Institut für Pathologie, Frankfurt, Deutschland
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T. Rau
- Universitätsklinikum Düsseldorf, Institut für Pathologie, Düsseldorf, Deutschland
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L. Lenders
- Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf, Deutschland
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M. Spahn
- Lindehofspital, Klinik für Urologie, Bern, Schweiz
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M. Boschheidgen
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
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G. Antoch
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
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T. Barrett
- School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Department of Radiology, Cambridge, UK
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L. Schimmöller
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
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Boris Hadaschik
- Universitätsklinikum Essen, Klinik für Urologie, Essen, Deutschland
| Published: | March 26, 2024 |
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Outline
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Introduction and objectives: There is evidence that multiparametric magnetic resonance imaging (mpMRI) may avoid repeat prostate biopsies in monitoring of patients during active surveillance (AS) for prostate cancer (PC). Particularly, serial MR scans are widely investigated using the PRECISE criteria. To assess the ability of PRECISE criteria to predict ISUP GG upgrading of men with ISUP GG1 on AS in a multi-institutional cohort.
Material and methods: Retrospective analysis of men from four centers (Cambridge, Düsseldorf, Dresden, Essen). After AS inclusion with mpMRI and MRI/TRUS fusion-guided biopsy, all men underwent serial mpMRI and MRI/TRUS fusion-guided biopsy subsequently. Patients with at least 2 MR scans and two biopsies (baseline and follow-up, the latter after the 2nd scan) were included. PRECISE recommendations evaluate the radiological change on serial imaging using a 1-to-5 scale in which PRECISE 1 or 2 indicates radiological regression, PRECISE 3 stability and PRECISE 4 or 5 imply progression. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of MRI progress (PRECISE≥4) for ISUP GG upgrading were calculated and plotted using Cumulative incidence curves, including log-rank tests for equality of cumulative incidence curve.
Results: In total, 396 men were available for analysis. Median follow-up was 36 months. Histopathological progression occurred in n=73 men (18%). For PRECISE 1–2 (n=27, 7% of cases) no progression occurred. In PRECISE 3 (n=254, 69%) progression rate was 4% and in PRECISE 4–5 (n=87, 24%) 36%. Sensitivity, specificity, PPV and NPV for PRECISE≥4 was 74%, 88%, 57% and 94%. Accuracy was 85%. Cumulative incidence curves are given in the figure [Fig. 1]. Log-Rank-test demonstrated statistical significance (p<0.001) for PRECISE 4–5.
Conclusions: This multi-institutional study has validated that a dedicated MRI-based scoring system of serial MRI scans can reliably aid to predict histopathological progress of men on AS within a median follow-up timespan of 36 months. In particular, men with MR progression are significantly at risk of ISUP GG upgrading.
