de Vos Ivo I, Marenghi Cristina, Badenchini Fabio, Boevé Egbert R, Lozano-Uruñuela Francisco, Graefen Markus, Rannikko Antti S, Staerman Frederic, Sugimoto Mikio, Kato Takuma, Somford Diederik M, Frydenberg Mark, Bangma Chris H, Remmers Sebastiaan, Roobol Monique J
Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
BJU Int. 2025 Aug;136(2):245-253. doi: 10.1111/bju.16727. Epub 2025 Apr 14.
To present the long-term outcomes of men with Grade Group (GG) 1 prostate cancer (PCa), included in the Prostate Cancer Research International Active Surveillance (PRIAS) study, and to assess the effect of the inclusion of magnetic resonance imaging (MRI) within the active surveillance (AS) protocol.
The PRIAS study is a multicentre, prospective, web-based cohort study monitoring patients on AS. In total, 8910 men with GG1 PCa were followed in 169 centres worldwide. The cumulative incidences of definitive treatment, metastasis and PCa-specific mortality (PCSM) were estimated using competing risk analyses. Additionally, multivariable analysis was performed to assess the risk of reclassification, stratified by MRI performed around the time of diagnosis.
The cumulative incidence of definitive treatment 15 years post-diagnosis was 55% (95% confidence interval [CI] 53-57). For metastasis, the 15-year cumulative incidence was 2.7% (95% CI 1.5-4.4). Eight men of died from PCa, resulting in a 15-year cumulative PCSM incidence of 0.23% (95% CI 0.09-0.54). Compared to men with no MRI around the time of diagnosis, those who underwent MRI during the first 18 months of AS were associated with a significantly higher risk of reclassification to ≥GG2, while men with a positive MRI before diagnosis were associated with a higher risk of reclassification to GG2, but not to ≥GG3. Men with GG2 PCa on MRI-targeted rebiopsy who underwent definitive treatment did not show a statistically significant higher risk of 5-year disease recurrence compared to those who had GG1 PCa on last biopsy during AS.
Our study confirms the safety of AS for GG1 PCa, with low metastasis and PCSM rates over 15 years. Furthermore, the inclusion of MRI in AS prompts increased detection of GG2, leading to increased treatment rates despite similar short-term risks. To minimise overtreatment, expanding eligibility for AS and the uptake of AS in men with favourable GG2 PCa is crucial to address the stage shift resulting from the increased accuracy of MRI.
呈现纳入国际前列腺癌主动监测（PRIAS）研究的1级前列腺癌（PCa）男性患者的长期预后，并评估在主动监测（AS）方案中纳入磁共振成像（MRI）的效果。
PRIAS研究是一项多中心、前瞻性、基于网络的队列研究，对接受AS的患者进行监测。全球169个中心共随访了8910例1级PCa男性患者。采用竞争风险分析估计确定性治疗、转移和前列腺癌特异性死亡率（PCSM）的累积发生率。此外，进行多变量分析以评估重新分类的风险，按诊断时周围进行的MRI分层。
诊断后15年确定性治疗的累积发生率为55%（95%置信区间[CI]53 - 57）。转移方面，15年累积发生率为2.7%（95%CI 1.5 - 4.4）。8名男性死于PCa，导致15年PCSM累积发生率为0.23%（95%CI 0.09 - 0.54）。与诊断时未进行MRI的男性相比，在AS的前18个月内接受MRI的男性重新分类为≥2级的风险显著更高，而诊断前MRI阳性的男性重新分类为2级的风险更高，但不是≥3级。在MRI靶向重复活检中为2级PCa且接受确定性治疗的男性与在AS期间最后一次活检为1级PCa的男性相比，5年疾病复发风险在统计学上无显著更高。
我们的研究证实了1级PCa主动监测的安全性，15年内转移和PCSM发生率较低。此外，在AS中纳入MRI促使2级的检测增加，尽管短期风险相似，但导致治疗率增加。为尽量减少过度治疗，扩大AS的适用范围以及让预后良好的2级PCa男性接受AS对于解决因MRI准确性提高导致的分期转变至关重要。
