Hougen Helen Y, Reis Isildinha M, Han Sunwoo, Prakash Nachiketh Soodana, Thomas Jamie, Stoyanova Radka, Castillo R Patricia, Kryvenko Oleksandr N, Ritch Chad R, Nahar Bruno, Gonzalgo Mark L, Gaston Sandra M, Abramowitz Matthew C, Dal Pra Alan, Mahal Brandon A, Pollack Alan, Parekh Dipen J, Punnen Sanoj
University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA, USA.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Prostate Cancer Prostatic Dis. 2025 Mar;28(1):180-186. doi: 10.1038/s41391-024-00898-w. Epub 2024 Sep 27.
4Kscore is used to aid the decision for prostate biopsy, however its role in active surveillance (AS) has not been investigated in a magnetic resonance imaging (MRI)-based protocol. Our objective was to assess the association between 4Kscore and progression in men undergoing AS on a prospective MRI-based protocol.
This was a single-institution, single-arm, non-therapeutic, interventional trial of 166 men with biopsy-confirmed prostate cancer enrolled between 2014-2020. Patients were placed on a trial-mandated AS protocol including yearly multiparametric (mp)MRI, prostate biopsy, and 4Kscore followed for 48 months after diagnosis. We analyzed protocol-defined and grade progression at confirmatory and subsequent surveillance biopsies.
Out of 166 patients, 83 (50%) men progressed per protocol and of them 41 (24.7% of whole cohort) progressed by grade. At confirmatory biopsy, men with a baseline 4Kscore ≥ 20% had a higher risk of grade progression compared to those with 4Kscore < 20% (OR = 4.04, 95% CI: 1.05-15.59, p = 0.043) after adjusting for National Comprehensive Cancer Network (NCCN) risk and baseline PIRADS score. At surveillance biopsies, most recent 4Kscore ≥ 20% significantly predicted per protocol (OR = 2.61, 95% CI: 1.03-6.63, p = 0.044) and grade progression (OR = 5.13, 95% CI: 1.63-16.11, p = 0.005).
For patients on AS, baseline 4Kscore predicted grade progression at confirmatory biopsy, and most recent 4Kscore predicted per-protocol and grade progression at surveillance biopsy.
4K评分用于辅助前列腺活检决策，然而其在基于磁共振成像（MRI）方案的主动监测（AS）中的作用尚未得到研究。我们的目的是评估在基于MRI的前瞻性方案中，4K评分与接受AS的男性病情进展之间的关联。
这是一项单机构、单臂、非治疗性的干预试验，纳入了2014年至2020年间166例经活检确诊为前列腺癌的男性。患者被纳入一项试验规定的AS方案，包括每年进行多参数（mp）MRI、前列腺活检和4K评分，诊断后随访48个月。我们分析了确诊活检和后续监测活检时方案定义的进展和分级进展情况。
166例患者中，83例（50%）按照方案病情进展，其中41例（占整个队列的24.7%）出现分级进展。在确诊活检时，调整美国国立综合癌症网络（NCCN）风险和基线前列腺影像报告和数据系统（PIRADS）评分后，基线4K评分≥20%的男性与4K评分<20%的男性相比，分级进展风险更高（比值比[OR]=4.04，95%置信区间[CI]：1.05 - 15.59，P=0.043）。在监测活检时，最近的4K评分≥20%显著预测了方案定义的进展（OR=2.61，95%CI：1.03 - 6.63，P=0.044）和分级进展（OR=5.13，95%CI：1.63 - 16.11，P=0.005）。
对于接受AS的患者，基线4K评分可预测确诊活检时的分级进展，而最近的4K评分可预测监测活检时的方案定义进展和分级进展。
