Progression and treatment rates using an active surveillance protocol incorporating image guided baseline biopsies and multi-parametric MRI monitoring for men with favourable risk prostate cancer

To assess early outcomes since the introduction of an active surveillance (AS) protocol incorporating mpMRI guided baseline biopsies and image based surveillance.

A new AS protocol mandating image-guided baseline biopsies, annual mpMRI and 3 monthly PSA but which retained protocol re-biopsies was tested. Pathological progression, treatment conversion and triggers for non-protocol biopsy were recorded prospectively.

Data from 157 men enrolled on this protocol (median: age 64years, PSA 6.8ng/ml, follow-up 39 months) was interrogated. 12 men (7.6%) left AS through patient choice. Of the 145 men who remained, 104 had re-biopsies either triggered by a PSA rise, MRI change or by protocol. Overall 23 men (15.8%) demonstrated disease progression; 20 from pathological changes and 3 from imaging changes. 17/23 of these switched to treatment giving a conversion rate of 11.7% (<4% per year). Of the 20 men with pathological progression 20% were detected from a PSA increase triggering a re-biopsy compared to 50% due to an mpMRI change. 30% however were detected solely from a protocol re-biopsy without prior PSA or MRI changes. Using PSA and MRI changes alone to detect progression demonstrated a sensitivity and specificity of 70.0% and 81.7% respectively.

An AS protocol with thorough baseline assessment and imaging based surveillance shows low rates of progression and treatment conversion. mpMRI changes were the principle trigger in detecting progression by imaging alone or pathologically. Protocol re-biopsy however still detected a significant number of pathological progressions without mpMRI or PSA changes. This article is protected by copyright. All rights reserved.

BJU international. 2018 Feb 13 [Epub ahead of print]

David Thurtle, Tristan Barrett, Vineetha Thankappan-Nair, Brendan Koo, Anne Warren, Christof Kastner, Kasra Saeb-Parsy, Jenna Kimberley-Duffell, Vincent J Gnanapragasam

Academic Urology Group, University of Cambridge, UK., Department of Radiology, Cambridge University Hospitals NHSFT, UK., Department of Urology, Cambridge University Hospitals NHSFT, UK., CamPARI-Clinic Cambridge Prostate Cancer Service, UK., Cambridge Urology, Translational Research and Clinical Trials, University of Cambridge, UK.