Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Eur Urol Oncol. 2021 Apr;4(2):227-234. doi: 10.1016/j.euo.2020.09.004. Epub 2020 Oct 21.
The ability of serial magnetic resonance imaging (MRI) to capture pathologic progression during active surveillance (AS) remains in question.
To determine whether changes in MRI are associated with pathologic progression for patients on AS.
DESIGN, SETTING, AND PARTICIPANTS: From July 2007 through January 2020, we identified all patients evaluated for AS at our institution. Following confirmatory biopsy, a total of 391 patients who underwent surveillance MRI and biopsy at least once were identified (median follow-up of 35.6 mo, interquartile range 19.7-60.6).
All MRI intervals were scored using the "Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation" (PRECISE) criteria, with PRECISE scores =4 considered a positive change in MRI. A generalized estimating equation-based logistic regression analysis was conducted for all intervals with a PRECISE score of <4 to determine the predictors of Gleason grade group (GG) progression despite stable MRI.
A total of 621 MRI intervals were scored by PRECISE and validated by biopsy. The negative predictive value of stable MRI (PRECISE score <4) was greatest for detecting GG1 to?=?GG3 disease (0.94 [0.91-0.97]). If 2-yr surveillance biopsy were performed exclusively for a positive change in MRI, 3.7% (4/109) of avoided biopsies would have resulted in missed progression from GG1 to?=?GG3 disease. Prostate-specific antigen (PSA) density (odds ratio 1.95 [1.17-3.25], p?=? 0.01) was a risk factor for progression from GG1 to =GG3 disease despite stable MRI.
In patients with GG1 disease and stable MRI (PRECISE score <4) on surveillance, grade progression to?=?GG3 disease is not common. In patients with grade progression detected on biopsy despite stable MRI, elevated PSA density appeared to be a risk factor for progression to?=?GG3 disease.
For patients with low-risk prostate cancer on active surveillance, the risk of progressing to grade group 3 disease is low with a stable magnetic resonance image (MRI) after 2?yr. Having higher prostate-specific antigen density increases the risk of progression, despite having a stable MRI.
在主动监测（AS）期间，连续磁共振成像（MRI）捕获病理进展的能力仍存在疑问。
确定 MRI 的变化是否与 AS 患者的病理进展相关。
设计、地点和参与者：从 2007 年 7 月至 2020 年 1 月，我们在本院确定了所有接受 AS 评估的患者。在确认活检后，共确定了 391 名至少接受过一次监测 MRI 和活检的患者（中位随访时间为 35.6 个月，四分位间距为 19.7-60.6）。
使用“前列腺癌放射学变化连续评估（PRECISE）”标准对所有 MRI 间隔进行评分，PRECISE 评分=4 被认为是 MRI 阳性变化。对所有 PRECISE 评分<4 的间隔进行基于广义估计方程的逻辑回归分析，以确定尽管 MRI 稳定但 Gleason 分级组（GG）进展的预测因素。
通过 PRECISE 对 621 个 MRI 间隔进行评分，并通过活检进行验证。稳定 MRI（PRECISE 评分<4）对检测 GG1 至?=?GG3 疾病的阴性预测值最大（0.94 [0.91-0.97]）。如果仅对 MRI 阳性变化进行 2 年监测活检，3.7%（4/109）避免活检将导致 GG1 至?=?GG3 疾病的进展漏诊。前列腺特异性抗原（PSA）密度（比值比 1.95 [1.17-3.25]，p?=?0.01）是 MRI 稳定时从 GG1 进展至?=?GG3 疾病的危险因素。
在监测中患有 GG1 疾病且 MRI 稳定（PRECISE 评分<4）的患者中，进展至?=?GG3 疾病并不常见。在活检中发现尽管 MRI 稳定但仍有分级进展的患者中，PSA 密度升高似乎是进展至?=?GG3 疾病的危险因素。
对于低危前列腺癌接受主动监测的患者，在 2 年后 MRI 稳定的情况下，进展为 3 级疾病的风险较低。尽管 MRI 稳定，但 PSA 密度较高会增加进展的风险。
