David Thurtle1,2, Tristan Barrett3,4, Vineetha Thankappan-Nair2,4, Brendan Koo3,4, Anne Warren4,5, Christof Kastner2,4, Kasra Saeb-Parsy2,4, Jenna Kimberley-Duffell6, Vincent J Gnanapragasam1,2,4,6. 1. Academic Urology Group, University of Cambridge, Cambridge, UK. 2. Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 3. Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 4. CamPARI-Clinic Cambridge Prostate Cancer Service, University of Cambridge, Cambridge, UK. 5. Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 6. Cambridge Urology, Translational Research and Clinical Trials, University of Cambridge, Cambridge, UK.
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.
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.
Authors: Eoin Dinneen; Gregory L Shaw; Roseann Kealy; Panos Alexandris; Kier Finnegan; Kimberley Chu; Nadia Haidar; Sara Santos-Vidal; Sakunthala Kudahetti; Caroline M Moore; Alistair D R Grey; Daniel M Berney; Anju Sahdev; Paul J Cathcart; R Timothy D Oliver; Prabhakar Rajan; Jack Cuzick; Jack Cuzick; Sanjeev Madaan; Jhumur Pati; Abdul M Chowdhury; Brian R P Birch; Timothy J Dudderidge; Caroline M Moore; Alistair D R Grey; Gregory L Shaw; Kieran P Jefferson; Howard G Kynaston; Prabhakar Rajan; James S A Green; Paul J Cathcart; Daniel M Berney; Thomas Powles; R Timothy D Oliver; Anju Sahdev; Roseann Kealy; Victoria Kemp; Panos Alexandris; Kier Finnegan; Kimberly Chu Journal: BJUI Compass Date: 2022-06-11
Authors: Kevin Michael Gallagher; Edward Christopher; Andrew James Cameron; Scott Little; Alasdair Innes; Gill Davis; Julian Keanie; Prasad Bollina; Alan McNeill Journal: BJU Int Date: 2018-10-09 Impact factor: 5.588