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

被引：50

作者：

Thurtle, David ^{[1
,2
]}

Barrett, Tristan ^{[3
,4
]}

Thankappan-Nair, Vineetha ^{[2
,4
]}

Koo, Brendan ^{[3
,4
]}

Warren, Anne ^{[4
,5
]}

Kastner, Christof ^{[2
,4
]}

Saeb-Parsy, Kasra ^{[2
,4
]}

Kimberley-Duffell, Jenna ^{[6
]}

Gnanapragasam, Vincent J. ^{[1
,2
,4
,6
]}

机构：

[1] Univ Cambridge, Acad Urol Grp, Cambridge, England

[2] Cambridge Univ Hosp NHS Fdn Trust, Dept Urol, Cambridge, England

[3] Cambridge Univ Hosp NHS Fdn Trust, Dept Radiol, Cambridge, England

[4] Univ Cambridge, CamPARI Clin, Cambridge Prostate Canc Serv, Cambridge, England

[5] Cambridge Univ Hosp NHS Fdn Trust, Dept Pathol, Cambridge, England

[6] Univ Cambridge, Cambridge Urol, Translat Res & Clin Trials, Cambridge, England

来源：

BJU INTERNATIONAL | 2018年 / 122卷 / 01期

关键词：

#PCSM; #ProstateCancer; localized prostate cancer; low-risk prostate cancer; active surveillance; mpMRI; TARGETED BIOPSY; SELECTION; FUSION; MRI; GUIDANCE; OUTCOMES;

D O I：

10.1111/bju.14166

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

ObjectiveTo 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 MethodsA 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. ResultsData from 157 men enrolled in the AS protocol (median age 64years, PSA 6.8ng/mL, follow-up 39months) 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. ConclusionOur 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.

引用

页码：59 / 65

页数：7

共 35 条

[1] The Emerging Role of MRI in Prostate Cancer Active Surveillance and Ongoing Challenges [J].