Prostate Cancer Patients Under Active Surveillance with a Suspicious Magnetic Resonance Imaging Finding Are at Increased Risk of Needing Treatment: Results of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium.
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Authors
Olivier, Jonathan
Li, Weiyu
Nieboer, Daan
Helleman, Jozien
Roobol, Monique
Gnanapragasam, Vincent
Frydenberg, Mark
Sugimoto, Mikio
Carroll, Peter
Morgan, Todd M
Valdagni, Riccardo
Rubio-Briones, Jose
Robert, Grégoire
Stricker, Phillip
Hayen, Andrew
Schoots, Ivo
Haider, Masoom
Moore, Caroline M
Denton, Brian
Villers, Arnauld
Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance GAP3 Consortium
Publication Date
2022-01Journal Title
Eur Urol Open Sci
ISSN
2666-1691
Publisher
Elsevier BV
Volume
35
Pages
59-67
Type
Article
This Version
VoR
Physical Medium
Electronic-eCollection
Metadata
Show full item recordCitation
Olivier, J., Li, W., Nieboer, D., Helleman, J., Roobol, M., Gnanapragasam, V., Frydenberg, M., et al. (2022). Prostate Cancer Patients Under Active Surveillance with a Suspicious Magnetic Resonance Imaging Finding Are at Increased Risk of Needing Treatment: Results of the Movember Foundation's Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium.. Eur Urol Open Sci, 35 59-67. https://doi.org/10.1016/j.euros.2021.11.006
Abstract
BACKGROUND: The inclusion criterion for active surveillance (AS) is low- or intermediate-risk prostate cancer. The predictive value of the presence of a suspicious lesion at magnetic resonance imaging (MRI) at the time of inclusion is insufficiently known. OBJECTIVE: To evaluate the percentage of patients needing active treatment stratified by the presence or absence of a suspicious lesion at baseline MRI. DESIGN SETTING AND PARTICIPANTS: A retrospective analysis of the data from the multicentric AS GAP3 Consortium database was conducted. The inclusion criteria were men with grade group (GG) 1 or GG 2 prostate cancer combined with prostate-specific antigen <20 ng/ml. We selected a subgroup of patients who had MRI at baseline and for whom MRI results and targeted biopsies were used for AS eligibility. Suspicious MRI was defined as an MRI lesion with Prostate Imaging Reporting and Data System (PI-RADS)/Likert ≥3 and for which targeted biopsies did not exclude the patient for AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was treatment free survival (FS). The secondary outcomes were histological GG progression FS and continuation of AS (discontinuation FS). RESULTS AND LIMITATIONS: The study cohort included 2119 patients (1035 men with nonsuspicious MRI and 1084 with suspicious MRI) with a median follow-up of 23 (12-43) mo. For the whole cohort, 3-yr treatment FS was 71% (95% confidence interval [CI]: 69-74). For nonsuspicious MRI and suspicious MRI groups, 3-yr treatment FS rates were, respectively, 80% (95% CI: 77-83) and 63% (95% CI: 59-66). Active treatment (hazard ratio [HR] = 2.0, p < 0.001), grade progression (HR = 1.9, p < 0.001), and discontinuation of AS (HR = 1.7, p < 0.001) were significantly higher in the suspicious MRI group than in the nonsuspicious MRI group. CONCLUSIONS: The risks of switching to treatment, histological progression, and AS discontinuation are higher in cases of suspicious MRI at inclusion. PATIENT SUMMARY: Among men with low- or intermediate-risk prostate cancer who choose active surveillance, those with suspicious magnetic resonance imaging (MRI) at the time of inclusion in active surveillance are more likely to show switch to treatment than men with nonsuspicious MRI.
Keywords
Active surveillance, Discontinuation, Magnetic resonance imaging, Nomogram, Prostate cancer, Worldwide
Identifiers
External DOI: https://doi.org/10.1016/j.euros.2021.11.006
This record's URL: https://www.repository.cam.ac.uk/handle/1810/333883
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc-nd/4.0/
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