(UroToday.com) At the 2021 European Association of Urology (EAU) annual meeting, Dr. Jonathan Olivier presents the outcomes of an active surveillance cohort stratified by MRI visible and non-visible lesions. This is part of the work from the GAP3 consortium.
The predictive value of the presence of a suspicious lesion on MRI at the time of active surveillance conclusion for switching to active treatment is insufficiently known. To answer this question the collaborators for this paper completed a retrospective analysis of data from the multi-center GAP3 consortium AS database. The coming objective of the study was to evaluate the percentage of patients needing active treatment stratified by the presence or absence of the suspicious lesion on baseline MRI.
Patients were included if they had GG1-2 prostate cancer and a PSA < 20. Patients must have had an MRI at baseline. They defined a suspicious MRI as any MRI with PIRADS/Likert 3-5 lesion, for which targeted biopsies did not exclude a patient from active surveillance.
The primary outcome was active treatment-free survival (FS). Secondary outcomes were histologic progression-free survival and discontinuation-free survival.
Their results are shown below:
Both groups, stratified by MRI status, were similar. GG2 in both cohorts ~11-12%.
They found that men with suspicious MRI at the time of AS initiation (baseline) were more likely to switch to active treatment, demonstrate histologic progression and AS discontinuation.
These results validate results from single-center studies that have previously reported on this topic (Stavrinides et al.1).
Based on these results, he concludes the following:
- We need active surveillance outcomes from international multicenter cohorts
- MRI has proven to increase staging and grading and as such has resulted in a decrease of 10% of reclassification rate within the first year of active surveillance
- While suspicious MRI may indicate that patient had to be more closely followed, a suspicious MRI does not necessarily exclude a patient from active surveillance.
- MRI results should be part of the inclusion criteria as an independent parameter to include and counsel patients at the beginning of active surveillance.
Presented by: Jonathan Olivier, MD, MSc, Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. of Lille Nord de France
Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Assistant Professor of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, @tchandra_uromd on Twitter during the 2021 European Association of Urology, EAU 2021- Virtual Meeting, July 8-12, 2021.
References:
1. Stavrinides V, Giganti F, Trock B, et al. Five-year Outcomes of Magnetic Resonance Imaging-based Active Surveillance for Prostate Cancer: A Large Cohort Study. Eur Urol. 2020 Sep;78(3):443-451. doi: 10.1016/j.eururo.2020.03.035. Epub 2020 Apr 30. PMID: 32360049; PMCID: PMC7443696.