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|Title:||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|
|Authors:||Thurtle, David;Barrett, Tristan;Thankappan-Nair, Vineetha;Koo, Brendan;Warren, Anne;Kastner, Christof;Saeb-Parsy, Kasra;Kimberley-Duffell, Jenna;Gnanapragasam, Vincent J.|
|Keywords:||#PCSM;#ProstateCancer;Active surveillance;Localized prostate cancer;Low-risk prostate cancer;MpMRI;10.1111/bju.14166|
|Abstract:||© 2018 BJU International. 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.|
|More Information:||VOLUME : 17 ISSUE : 2 START PAGE : e1895 END PAGES : e1896|
|Appears in Collections:||EUA Update Series|
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|2018 EUAUS Volume 17 Issue 2 March (1303).pdf||130.52 kB||Adobe PDF|
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