Active surveillance eligibility of MRI-positive patients with grade group 2 prostate cancer: a pathological study
Tóm tắt
To assess the final pathology risk in MRI-positive grade group (GG) 2 prostate cancer (PCa) patients undergoing targeted (TB) and systematic (SB) biopsies, and thereby, the possibility of active surveillance (AS) in this population. We included 242 consecutive men diagnosed with GG2 PCa by a combination of SB and software-based fusion TB undergoing a radical prostatectomy (RP). The primary endpoints were the pathological findings in RP specimens, including favourable disease which was defined by a pT2 and GG1–2 disease. The rate of upgrading was 33% including 3% of GG 4–5 disease. MRI lesion size (p = 0.038) and tumor length per core (p < 0.001) were significantly lower in case of favourable pathology. Only 34.2% of not organ-confined disease was reported when only SB were positive, compared with 45.7% and 57.1% when GG2 was detected on TB only and on TB plus SB, respectively (p = 0.035). The number of positive cores on SB was significantly higher in not organ-confined disease (4.3 versus 2.9; p = 0.005). The risk of not organ-confined disease was only 20.8% in men who had a PSAD ≤ 0.20 ng/ml/gr, 1–2 positive biopsies and a maximal tumor length ≤ 6 mm per core, compared with 52.3% in men who did not fulfil all these criteria (p = 0.003). This study identified clinical, imaging, and pathological factors that were significantly associated with the final pathology risk. In case of positive MRI followed by TB showing GG2, AS could be offered in patients having a PSAD ≤ 0.20, a tumor length ≤ 6 mm and 1–2 positive cores.
Tài liệu tham khảo
Mottet N, Bellmunt J, Bolla M et al (2017) EAU–ESTRO–SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:618–629
Loeb S, Berglund A, Stattin P (2013) Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol 190:1742–1749
Balakrishnan AS, Cowan JE, Cooperberg MR et al (2019) Evaluating the safety of active surveillance: outcomes of deferred radical prostatectomy after an initial period of surveillance. J Urol. https://doi.org/10.1097/JU.00247
Kornberg Z, Cowan JE, Westphalen AC et al (2019) Genomic prostate score, PI-RADS™ version 2 and progression in men with prostate cancer on active surveillance. J Urol 201:300–307
Loeb S, Folkvaljon Y, Makarov DV, Bratt O, Bill-Axelson A, Stattin P (2015) Five-year nationwide follow-up study of active surveillance for prostate cancer. Eur Urol 67:233–238
Musunuru HB, Yamamoto T, Klotz L et al (2016) Active surveillance for intermediate risk prostate cancer: survival outcomes in the sunnybrook experience. J Urol 196:1651–1658
Loeb S, Folkvaljon Y, Bratt O, Robinson D, Stattin P (2019) Defining intermediate risk prostate cancer suitable for active surveillance. J Urol 201:292–299
Cooperberg MR, Cowan JE, Hilton JF et al (2011) Outcomes of active surveillance for men with intermediate-risk prostate cancer. J Clin Oncol 29:228–234
Gandaglia G, van den Bergh RCN, Tilki D et al (2018) How can we expand active surveillance criteria in patients with low- and intermediate-risk prostate cancer without increasing the risk of misclassification? Development of a novel risk calculator. BJU Int 122:823–830
Höffkes F, Arthanareeswaran V, Stolzenburg J, Ganzer R (2018) Rate of misclassification in patients undergoing radical prostatectomy but fulfilling active surveillance criteria according to the European association of urology guidelines on prostate cancer: a high-volume center experience. Minerva Urol Nefrol 70:588–593
Schoots IG, Petrides N, Giganti F et al (2015) Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol 67:627–636
Kasivisvanathan V, Rannikko AS, Borghi M et al (2018) MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 378:1767–1777
Siddiqui MM, George AK, Rubin R et al (2016) Efficiency of prostate cancer diagnosis by mr/ultrasound fusion-guided biopsy vs standard extended-sextant biopsy for MR-visible lesions. J Natl Cancer Inst 108:djw039
Covin B, Roumiguié M, Quintyn-Ranty ML et al (2018) Refining the risk-stratification of transrectal biopsy-detected prostate cancer by elastic fusion registration transperineal biopsies. World J Urol. https://doi.org/10.1007/s00345-018-2459-4
Tran GN, Leapman MS, Nguyen HG et al (2017) Magnetic resonance imaging-ultrasound fusion biopsy during prostate cancer active surveillance. Eur Urol 72:275–281
Barentsz JO, Richenberg J, Clements R et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22:746–757
Barentsz JO, Weinreb JC, Verma S et al (2016) Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imag-ing and recommendations for use. Eur Urol 69:41–49
Bul M, van den Bergh RC, Zhu X et al (2012) Outcomes of initially expectantly managed patients with low or intermediate risk screen-detected localized prostate cancer. BJU Int 110:1672–1677
Masic S, Washington SL 3rd, Carroll PR (2017) Management of intermediate-risk prostate cancer with active surveillance: never or sometimes? Curr Opin Urol 27:231–237
Capitanio U, Karakiewicz PI, Valiquette L et al (2009) Biopsy core number represents one of foremost predictors of clinically significant gleason sum upgrading in patients with low-risk prostate cancer. Urology 73:1087–1091
Gold SA, Hale GR, Bloom JB et al (2018) Follow-up of negative MRI-targeted prostate biopsies: when are we missing cancer? World J Urol. https://doi.org/10.1007/s00345-018-2337-0
Westhoff N, Siegel FP, Hausmann D et al (2017) Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms. World J Urol 35:1015–1022
Schouten MG, van der Leest M, Pokorny M et al (2017) Why and where do we miss significant prostate cancer with multi-parametric magnetic resonance imaging followed by magnetic resonance-guided and transrectal ultrasound-guided biopsy in biopsy-naïve men? Eur Urol 71:896–903
Ploussard G, Salomon L, Xylinas E et al (2010) Pathological findings and prostate specific antigen outcomes after radical prostatectomy in men eligible for active surveillance–Does the risk of misclassification vary according to biopsy criteria? J Urol 183:539–544
Conti SL, Dall’era M, Fradet V, Cowan JE, Simko J, Carroll PR (2009) Pathological outcomes of candidates for active surveillance of prostate cancer. J Urol 181:1628–1633
Suardi N, Capitanio U, Chun FK et al (2008) Currently used criteria for active surveillance in men with low-risk prostate cancer: an analysis of pathologic features. Cancer 113:2068–2072
Cornud F, Roumiguié M, Barry de Longchamps N et al (2018) Precision matters in MR imaging-targeted prostate biopsies: evidence from a prospective study of cognitive and elastic fusion registration transrectal biopsies. Radiology 287:534–542