Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
J Urol. 2020 Dec;204(6):1229-1235. doi: 10.1097/JU.0000000000001307. Epub 2020 Jul 27.
We identified baseline imaging and clinical characteristics of patients that may improve risk stratification among patients being evaluated for active surveillance.
From July 2007 to January 2020 patients referred to our institution for prostate cancer were evaluated and those who remained on active surveillance were identified. Men underwent multiparametric magnetic resonance imaging upon entry into our active surveillance protocol during which baseline demographic and imaging data were documented. Patients were then followed and outcomes, specifically progression to Gleason Grade Group (GG)3 or greater disease, were recorded.
Of the men placed on active surveillance 344 had at least 1 PI-RADS score documented. For those with an index lesion PI-RADS category of 5, 33% (17/51) had progression to GG3 or greater on active surveillance with a median time to progression of 31 months. When comparing the progression-free survival times and progression rates in each category, PI-RADS category was found to be associated with progression to GG3 or greater on active surveillance (p <0.01). On univariable analysis factors associated with progression included an index lesion PI-RADS category of 5, prostate specific antigen density and the size of the largest lesion. On multivariable analysis only PI-RADS category of 5 and prostate specific antigen density were associated with progression on active surveillance.
PI-RADS lesion categories at baseline multiparametric magnetic resonance imaging during active surveillance enrollment can be used to predict cancer progression to GG3 or greater on active surveillance. This information, along with other clinical data, can better assist urologists in identifying and managing patients appropriate for active surveillance.
我们确定了基线影像学和临床特征，这些特征可能会提高接受主动监测评估的患者的风险分层。
从 2007 年 7 月至 2020 年 1 月，我们对转诊到我院进行前列腺癌评估的患者进行了评估，并确定了仍在接受主动监测的患者。男性在进入我们的主动监测方案时接受多参数磁共振成像检查，在此期间记录了基线人口统计学和影像学数据。然后对患者进行随访，并记录结果，特别是进展为 Gleason 分级组（GG）3 或更高的疾病。
在接受主动监测的男性中，有 344 人至少有 1 个 PI-RADS 评分记录。对于指数病变 PI-RADS 类别为 5 的患者，33%（17/51）在主动监测中有进展为 GG3 或更高的疾病，中位进展时间为 31 个月。当比较每个类别中的无进展生存时间和进展率时，发现 PI-RADS 类别与主动监测中的 GG3 或更高进展相关（p <0.01）。单变量分析中，与进展相关的因素包括指数病变 PI-RADS 类别为 5、前列腺特异性抗原密度和最大病变的大小。多变量分析仅显示 PI-RADS 类别为 5 和前列腺特异性抗原密度与主动监测中的进展相关。
主动监测入组时多参数磁共振成像的基线 PI-RADS 病变类别可用于预测主动监测中癌症进展为 GG3 或更高。这些信息以及其他临床数据，可以更好地帮助泌尿科医生识别和管理适合主动监测的患者。
