Academic Urology Group, University of Cambridge, Cambridge, UK.
Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
BJU Int. 2018 Jul;122(1):59-65. doi: 10.1111/bju.14166. Epub 2018 Mar 8.
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.
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.
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.
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.
评估引入包含多参数磁共振成像（mpMRI）引导基线活检和基于图像监测的主动监测（AS）方案后的早期结果。
本研究测试了一种新的 AS 方案，该方案要求进行图像引导的基线活检、每年进行 mpMRI 检查和每 3 个月进行前列腺特异性抗原（PSA）检测，但保留了方案重活检。前瞻性记录了病理进展、治疗转换和非方案活检的触发因素。
研究纳入了 157 名接受 AS 方案的男性患者（中位年龄 64 岁，PSA 6.8ng/ml，随访 39 个月）的数据。共有 12 名男性（7.6%）自愿退出 AS 计划。在 145 名仍在接受监测的男性中，104 名因 PSA 水平升高、mpMRI 结果变化或方案要求进行了重活检。总的来说，23 名男性（15.9%）发生疾病进展；20 名男性出现病理变化，3 名男性出现影像学结果变化。在这 23 名男性中，17 名转为治疗，转化率为 11.7%（<4%/年）。在 20 名出现病理进展的男性中，其中 4 名在 PSA 增加触发重活检后发现进展，而 10 名在 mpMRI 变化后发现进展。在 6 名男性中，仅在没有 PSA 或 mpMRI 变化的情况下进行方案重活检后发现进展。单独使用 PSA 和 mpMRI 变化来检测进展的敏感性和特异性分别为 70.0%和 81.7%。
我们的 AS 方案，通过彻底的基线评估和基于影像学的监测，显示出较低的进展和治疗转换率。mpMRI 结果变化是单独通过影像学或病理学检测进展的主要触发因素；然而，根据方案进行重活检仍然在没有 mpMRI 或 PSA 变化的情况下检测到大量的病理进展。
