Department of Urology, Wayne State University, Detroit, MI.
Department of Urology, Wayne State University, Detroit, MI.
Urology. 2021 Jan;147:213-222. doi: 10.1016/j.urology.2020.07.067. Epub 2020 Sep 15.
To assess the impact of confirmatory tests on active surveillance (AS) biopsy disease reclassification and progression to treatment in men with favorable risk prostate cancer (FRPC).
We searched the MUSIC registry for men with FRPC managed with AS without or with a confirmatory test. Confirmatory tests included (1) repeat prostate biopsy, (2) genomic tests, (3) prostate magnetic resonance imaging (MRI), or (4) MRI followed by a post-MRI biopsy. Confirmatory test results were deemed reassuring (RA) or nonreassuring (nonRA) according to predefined criteria. Kaplan-Meier curves and multivariable Cox regression models were used to compare surveillance biopsy disease reclassification-free survival and treatment-free survival.
Of the 2,514 men with FRPC who were managed on AS, 1211 (48%) men obtained a confirmatory test. We noted differences in the 12-month unadjusted surveillance biopsy disease reclassification-free probability (68%, 83%, and 90%, P < .0001) and 24-month unadjusted treatment-free probability (55%, 81%, and 79%, P < .0001), for men with nonRA confirmatory tests, no confirmatory test, and RA confirmatory tests, respectively. Excluding patients with genomic confirmatory tests, men with RA confirmatory tests were associated with a lower hazard (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.38-0.84, P = .005) and men with nonRA confirmatory tests had an increased hazard (HR 1.97, 95% CI 1.22-3.19, P = .006) of surveillance disease reclassification compared with men without confirmatory tests in the multivariable model.
These data suggest men with RA confirmatory tests have less surveillance biopsy reclassification and remain on AS longer than men with nonRA test results. Confirmatory tests may help risk stratify men considering active surveillance.
评估确认性检测对主动监测（AS）活检疾病再分类以及有利风险前列腺癌（FRPC）患者向治疗进展的影响。
我们在 MUSIC 注册中心检索了接受 AS 治疗且未进行或进行了确认性检测的 FRPC 男性患者。确认性检测包括（1）重复前列腺活检，（2）基因组检测，（3）前列腺磁共振成像（MRI），或（4）MRI 后行 MRI 引导下活检。根据预设标准，将确认性检测结果判定为“令人安心（RA）”或“不令人安心（nonRA）”。我们使用 Kaplan-Meier 曲线和多变量 Cox 回归模型比较了监测活检疾病再分类无进展生存率和治疗无进展生存率。
在接受 FRPC AS 治疗的 2514 名男性中，有 1211 名（48%）男性进行了确认性检测。我们注意到，不进行确认性检测、进行非 RA 确认性检测和进行 RA 确认性检测的男性，在 12 个月时未调整的监测活检疾病再分类无进展概率（68%、83%和 90%，P <.0001）和 24 个月时未调整的治疗无进展概率（55%、81%和 79%，P <.0001）存在差异。排除接受基因组确认性检测的患者后，RA 确认性检测与较低的风险（风险比 [HR] 0.57，95%置信区间 [CI] 0.38-0.84，P =.005）相关，而非 RA 确认性检测与较高的风险（HR 1.97，95% CI 1.22-3.19，P =.006）相关，即与未进行确认性检测的男性相比，前者的监测疾病再分类风险增加。
这些数据表明，RA 确认性检测的男性发生监测活检再分类的情况更少，并且在 AS 上的时间也更长，而非 RA 检测结果的男性则相反。确认性检测可能有助于对考虑接受主动监测的男性进行风险分层。
