What is the effect of MRI with targeted biopsies on the rate of patients discontinuing active surveillance? A reflection of the use of MRI in the PRIAS study.

Autor: Luiting HB; Department of Urology, Erasmus University Medical Centre Cancer Institute, Rotterdam, The Netherlands. h.luiting@erasmusmc.nl., Remmers S; Department of Urology, Erasmus University Medical Centre Cancer Institute, Rotterdam, The Netherlands., Valdagni R; Department of Oncology and Haemato-oncology, Università degli Studi di Milano. Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Boevé ER; Department of Urology, Sint Franciscus Hospital, Rotterdam, The Netherlands., Staerman F; Department of Urology, Polycliniques REIMS-BEZANNES, Reims, France., Rueb J; Department of Urology, Marien Hospital Herne, Herne, Germany., Somford DM; Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., Pickles T; Department of Radiation Oncology, Vancouver Center, BC Cancer, Vancouver, BC, Canada., Rannikko A; Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.; Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland., Roobol MJ; Department of Urology, Erasmus University Medical Centre Cancer Institute, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Prostate cancer and prostatic diseases [Prostate Cancer Prostatic Dis] 2021 Dec; Vol. 24 (4), pp. 1048-1054. Date of Electronic Publication: 2021 Apr 08.
DOI: 10.1038/s41391-021-00343-2
Abstrakt: Background: The reduction of overtreatment by active surveillance (AS) is limited in patients with low-risk prostate cancer (PCa) due to high rates of patients switching to radical treatment. MRI improves biopsy accuracy and could therewith affect inclusion in or continuation of AS. We aim to assess the effect of MRI with target biopsies on the total rate of patients discontinuing AS, and in particular discontinuation due to Grade Group (GG) reclassification.
Methods: Three subpopulations included in the prospective PRIAS study with GG 1 were studied. Group A consists of patients diagnosed before 2009 without MRI before or during AS. Group B consists of patients diagnosed without MRI, but all patients underwent MRI within 6 months after diagnosis. Group C consists of patients who underwent MRI before diagnosis and during follow-up. We used cumulative incidence curves to estimate the rates of discontinuation.
Results: In Group A (n = 500), the cumulative probability of discontinuing AS at 2 years is 27.5%; GG reclassification solely accounted for 6.9% of the discontinuation. In Group B (n = 351) these numbers are 30.9 and 22.8%, and for Group C (n = 435) 24.2 and 13.4%. The three groups were not randomized, however, baseline characteristics are highly comparable.
Conclusions: Performing an MRI before starting AS reduces the cumulative probability of discontinuing AS at 2 years. Performing an MRI after already being on AS increases the cumulative probability of discontinuing AS in comparison to not performing an MRI, especially because of an increase in GG reclassification. These results suggest that the use of MRI could lead to more patients being considered unsuitable for AS. Considering the excellent long-term cancer-specific survival of AS before the MRI era, the increased diagnostic accuracy of MRI could potentially lead to more overtreatment if definitions and treatment options of significant PCa are not adapted.
(© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)
Databáze: MEDLINE
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