Active surveillance (AS) is the recommended approach for managing Grade-Group1 (GG1) prostate cancer (PCa). Incorporating MRI at entry improve patient selection and outcomes.
To evaluate long-term oncological outcomes of patients receiving AS selected with MRI at entry.
Retrospective analysis of a single-center cohort of patients selected for AS from 2007 to 2022. Inclusion criteria were GG1 PCa with MRI prior to systematic and targeted biopsies. A per-protocol rebiopsy at one year has not been part of the AS inclusion criteria since 2015. Main outcome was cumulative incidence of: biopsy grade reclassification, AS discontinuation, active treatment, post active-treatment biochemical recurrence, metastasis, and mortality. Secondary outcome was the identification of risk factors for AS discontinuation.
Cohort consists of 354 men. Median follow-up is 6.3 years (IQR:3.2-9.1). Median PSA was 6.3ng/ml (5.0 to 8.5). At 10 years post-diagnosis, the cumulative incidence was 29.6% (95%CI:23.3%-36.2%) for grade reclassification, 40.0% (95%CI:32.8%-47.0%) for AS discontinuation, 36.9% (95% CI: 30.0 to 43.7) for active treatment, 9.4% (95% CI: 3.7-18.4) for post active-treatment biochemical recurrence and 0.5% for metastatic progression (2 patients). No PCa-related deaths were observed. PIRADS score, and the number of positive biopsies at inclusion were identified as predictive factors for AS discontinuation.
In this cohort of AS patients with MRI at entry, 60% of men remained on AS at 10 years, with less than 1% developing metastatic disease and no PCa-related mortality. These results support AS management with MRI at entry and add to share decision-making with patients.
The French journal of urology. 2024 Dec 20 [Epub ahead of print]
T Benheddi, D Seguier, P Puech, X Leroy, E Cailliau, H Behal, A Villers, J Olivier
Department of Urology, Univ. Lille, Lille, France., Department of Radiology, Univ. Lille, Lille, France., Department of Histopathology, Univ. Lille, Lille, France., CHU Lille, Department of Biostatistics, F-59000 France., Department of Urology, Univ. Lille, Lille, France. Electronic address: .