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Thurtle D, Barrett T, Thankappan-Nair V, Koo B, Warren A, Kastner C, Saeb-Parsy K, Kimberley-Duffell J, Gnanapragasam VJ. Progression and treatment rates using an active surveillance protocol incorporating image-guided baseline biopsies and multiparametric magnetic resonance imaging monitoring for men with favourable-risk prostate cancer. BJU Int 2018; 122:59-65. [PMID: 29438586 DOI: 10.1111/bju.14166] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess early outcomes since the introduction of an active surveillance (AS) protocol incorporating multiparametric magnetic resonance imaging (mpMRI)-guided baseline biopsies and image-based surveillance. PATIENTS AND METHODS A new AS protocol mandating image-guided baseline biopsies, annual mpMRI and 3-monthly prostate-specific antigen (PSA) testing, but which retained protocol re-biopsies, was tested. Pathological progression, treatment conversion and triggers for non-protocol biopsy were recorded prospectively. RESULTS Data from 157 men enrolled in the AS protocol (median age 64 years, PSA 6.8 ng/mL, follow-up 39 months) were interrogated. A total of 12 men (7.6%) left the AS programme by choice. Of the 145 men who remained, 104 had re-biopsies either triggered by a rise in PSA level, change in mpMRI findings or by protocol. Overall, 23 men (15.9%) experienced disease progression; pathological changes were observed in 20 men and changes in imaging results were observed in three men. Of these 23 men, 17 switched to treatment, giving a conversion rate of 11.7% (<4% per year). Of the 20 men with pathological progression, this was detected in four of them after a PSA increase triggered a re-biopsy, while in 10 men progression was detected after an mpMRI change. Progression was detected in six men, however, solely after a protocol re-biopsy without prior PSA or mpMRI changes. Using PSA and mpMRI changes alone to detect progression was found to have a sensitivity and specificity of 70.0% and 81.7%, respectively. CONCLUSION Our AS protocol, with thorough baseline assessment and imaging-based surveillance, showed low rates of progression and treatment conversion. Changes in mpMRI findings were the principle trigger for detecting progression by imaging alone or pathologically; however, per protocol re-biopsy still detected a significant number of pathological progressions without mpMRI or PSA changes.
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Affiliation(s)
- David Thurtle
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK
| | - Vineetha Thankappan-Nair
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK
| | - Brendan Koo
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK
| | - Anne Warren
- CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christof Kastner
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK
| | - Kasra Saeb-Parsy
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK
| | - Jenna Kimberley-Duffell
- Cambridge Urology, Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
| | - Vincent J Gnanapragasam
- Academic Urology Group, University of Cambridge, Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK
- Cambridge Urology, Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK
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