Kimbel Isabella M, Wallaengen Veronica, Zacharaki Evangelia I, Breto Adrian L, Algohary Ahmad, Carbohn Sophia, Gaston Sandra M, Soodana-Prakash Nachiketh, Freitas Pedro F S, Kryvenko Oleksandr N, Castillo Patricia, Abramowitz Matthew C, Ritch Chad R, Nahar Bruno, Gonzalgo Mark L, Parekh Dipen J, Pollack Alan, Punnen Sanoj, Stoyanova Radka
Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA (I.M.K., V.W., E.I.Z., A.L.B., A.A., S.C., S.M.G., M.C.A., A.P., R.S.).
Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA (I.M.K., V.W., E.I.Z., A.L.B., A.A., S.C., S.M.G., M.C.A., A.P., R.S.); Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA (V.W., N.S.-P., P.F.S.F., C.R.R., B.N., M.L.G., D.J.P., S.P.).
Acad Radiol. 2025 Apr;32(4):2081-2089. doi: 10.1016/j.acra.2024.11.008. Epub 2024 Dec 17.
Active surveillance (AS) is the preferred management strategy for low-risk prostate cancer. This study aimed to evaluate the impact of Habitat Risk Score (HRS), an automated approach for mpMRI analysis, for early detection of progressors in a prospective AS clinical trial (MAST NCT02242773).
The MAST protocol includes Confirmatory mpMRI ultrasound fusion (MRI-US) biopsy and yearly surveillance MRI-US biopsies for up to 3 years. Clinical and mpMRI data from patients that progressed based on protocol criteria at years 1-3 were reviewed. Patients were classified as "MRI/HRS Progressors" if the PI-RADS lesion(s) had been targeted throughout the surveillance and resulted in positive biopsies, or as "Missed Progressors" if the lesion(s) were not identified by PI-RADS ("PI-RADS Miss") or were missed by the biopsy ("Needle Miss"). HRS maps were generated for each patient and evaluated for association with histopathological progression.
Of the 34 patients, 15 were classified as "MRI/HRS Progressors" and 19 as "Missed Progressors" (12 "PI-RADS Miss", seven "Needle Miss"). In all cases, HRS confirmed the PI-RADS assessment. In the "PI-RADS Miss" group, HRS identified the lesions in all patients that were not targeted by biopsy and resulted in patient reclassification. HRS volumes showed clear association with tumor evolution both in terms of volume and aggressiveness over time.
HRS volumes can serve as a quantitative biomarker for early detection of progression and lead to timely conversion to treatment, thereby improving patient outcomes and reducing the burden of unnecessary surveillance.
主动监测（AS）是低风险前列腺癌的首选管理策略。本研究旨在评估一种用于多参数磁共振成像（mpMRI）分析的自动化方法——栖息地风险评分（HRS），在前瞻性主动监测临床试验（MAST NCT02242773）中对疾病进展者进行早期检测的影响。
MAST方案包括确认性mpMRI超声融合（MRI-US）活检以及长达3年的每年一次监测性MRI-US活检。回顾了1至3年期间根据方案标准病情进展的患者的临床和mpMRI数据。如果在整个监测过程中PI-RADS病变被作为活检目标且活检结果为阳性，则将患者分类为“MRI/HRS进展者”；如果病变未被PI-RADS识别（“PI-RADS漏诊”）或被活检遗漏（“穿刺漏诊”），则分类为“漏诊进展者”。为每位患者生成HRS图谱，并评估其与组织病理学进展的相关性。
34例患者中，15例被分类为“MRI/HRS进展者”，19例为“漏诊进展者”（12例“PI-RADS漏诊”，7例“穿刺漏诊”）。在所有病例中，HRS均证实了PI-RADS评估结果。在“PI-RADS漏诊”组中，HRS识别出了所有未被活检作为目标的病变患者，并导致了患者重新分类。HRS体积在体积和随时间的侵袭性方面均显示出与肿瘤进展有明显关联。
HRS体积可作为疾病进展早期检测的定量生物标志物，并导致及时转为治疗，从而改善患者预后并减轻不必要监测的负担。
