Clinical experience with active surveillance protocol using regular magnetic resonance imaging instead of regular repeat biopsy for monitoring: A study at a high-volume center in Korea

Abstract

Background Here, we report the experience of a multiparameter magnetic resonance imaging (MRI)–based active surveillance (AS) protocol that did not include performing a repeat biopsy after the diagnosis of prostate cancer by prostate biopsy or transurethral resection of prostate. Methods From January 2010 to December 2017, we reviewed 193 patients with newly diagnosed prostate cancer who were eligible for AS. The patients were divided into AS group (n = 122) and definitive treatment group (n = 71) based on initial treatment. Disease progression was defined as a remarkable change in MRI findings. To confirm the stability of protocol, we compared the clinicopathological characteristics of patients who initially underwent radical prostatectomy (RP) (n = 58) and RP after termination of AS (n = 20). Results Among patients who initially selected AS (median adherence duration = 31.4 months), 70 (57.3%) subsequently changed their treatment options. Disease progression (n = 30) was the main cause for termination. No significant differences were found in the clinicopathologic characteristics at initial diagnosis and pathologic outcomes between patients who initially underwent RP and those who chose RP after termination of AS. In a comparative analysis of diagnostic methods, the patients with incidental prostate cancer by transurethral resection of prostate had higher age, lower prostate-specific antigen level and density, as well as longer AS adherence duration and follow-up duration compared with those diagnosed by prostate biopsy. Conclusions Our AS monitoring protocol, which depends on MRI instead of regular repeat biopsy, was feasible. Patients with incidental prostate cancer continued AS more compared with patients diagnosed by prostate biopsy.

Temporal changes of PIRADS scoring by radiologists and correlation to radical prostatectomy pathological outcomes

“…In our study, low risk tumors confirmed at RP were correlated with increasing categorization as PIRADS 1–3 and intermediate–high-risk tumors as PIRADS 4-5 with increased experience over time, with improvements in PIRADS 5 for SVI and BNI detection. These results suggest that high PIRADS in experienced centers can more accurately predict poor pathologic features after RP and caution against MRI-dependent clinical decision making in low volume institutions, especially when considering candidates for active surveillance 34 , 35 . Further large-scale prospective trials are required to validate our results.…”

Usefulness of grayscale values measuring hypoechoic lesions for predicting prostate cancer: An experimental pilot study

“…Data are reported as median (interquartile range) for continuous variables and as a number of occurrences (frequency) for categorical variables. The Pearson χ 2 test was used to statistically compare continuous and categorical variables. Simple and multiple logistic regression analyses were used to predict PCA and cs-PCA.…”

“…Unlike other solid organ cancers where imaging plays a pivotal role in identifying patients requiring biopsy, prostate cancer (PCA) is diagnosed by 10–12 random core prostate biopsies (PBxs) from 10–12 areas in the prostate. 1 , 2 , 3 Recently, prebiopsy magnetic resonance imaging (MRI) has been recommended in the National Comprehensive Cancer Network (NCCN) guidelines based on results of improving prediction of clinically significant PCA (cs-PCA). 4 , 5 , 6 Furthermore, introducing MRI/transrectal ultrasonography (TRUS) fusion biopsy reduces sampling error and improves risk stratification.…”

Establishment of Prospective Registry of Active Surveillance for Prostate Cancer: The Korean Urological Oncology Society Database

“…This may be related to anxiety among Korean characteristics. Ahn et al [ 30 ] showed that except for disease progression as the reason for terminating AS, patient’s anxiety was selected as the main reason. The accumulated data and information on this can be an important issue to consider in analyzing data of AS of Koreans.…”