What is the effect of MRI with targeted biopsies on the rate of patients discontinuing active surveillance? A reflection of the use of MRI in the PRIAS study

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PRIAS Consortium , Luiting , H B , Remmers , S , Valdagni , R , Rannikko , A & Roobol , M J 2021 , ' What is the effect of MRI with targeted biopsies on the rate of patients discontinuing active surveillance? A reflection of the use of MRI in the PRIAS study ' , Prostate Cancer and Prostatic Diseases , vol. 24 , no. 4 , pp. 1048-1054 . https://doi.org/10.1038/s41391-021-00343-2

Title: What is the effect of MRI with targeted biopsies on the rate of patients discontinuing active surveillance? A reflection of the use of MRI in the PRIAS study
Author: PRIAS Consortium; Luiting, H. B.; Remmers, S.; Valdagni, R.; Rannikko, A.; Roobol, M. J.
Contributor organization: HUS Abdominal Center
Clinicum
Urologian yksikkö
Department of Surgery
Research Program in Systems Oncology
Research Programs Unit
Date: 2021-12
Language: eng
Number of pages: 7
Belongs to series: Prostate Cancer and Prostatic Diseases
ISSN: 1365-7852
DOI: https://doi.org/10.1038/s41391-021-00343-2
URI: http://hdl.handle.net/10138/340357
Abstract: Background The reduction of overtreatment by active surveillance (AS) is limited in patients with low-risk prostate cancer (PCa) due to high rates of patients switching to radical treatment. MRI improves biopsy accuracy and could therewith affect inclusion in or continuation of AS. We aim to assess the effect of MRI with target biopsies on the total rate of patients discontinuing AS, and in particular discontinuation due to Grade Group (GG) reclassification. Methods Three subpopulations included in the prospective PRIAS study with GG 1 were studied. Group A consists of patients diagnosed before 2009 without MRI before or during AS. Group B consists of patients diagnosed without MRI, but all patients underwent MRI within 6 months after diagnosis. Group C consists of patients who underwent MRI before diagnosis and during follow-up. We used cumulative incidence curves to estimate the rates of discontinuation. Results In Group A (n = 500), the cumulative probability of discontinuing AS at 2 years is 27.5%; GG reclassification solely accounted for 6.9% of the discontinuation. In Group B (n = 351) these numbers are 30.9 and 22.8%, and for Group C (n = 435) 24.2 and 13.4%. The three groups were not randomized, however, baseline characteristics are highly comparable. Conclusions Performing an MRI before starting AS reduces the cumulative probability of discontinuing AS at 2 years. Performing an MRI after already being on AS increases the cumulative probability of discontinuing AS in comparison to not performing an MRI, especially because of an increase in GG reclassification. These results suggest that the use of MRI could lead to more patients being considered unsuitable for AS. Considering the excellent long-term cancer-specific survival of AS before the MRI era, the increased diagnostic accuracy of MRI could potentially lead to more overtreatment if definitions and treatment options of significant PCa are not adapted.
Subject: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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