Image-based monitoring of targeted biopsy-proven prostate cancer on active surveillance: 11-year experience.

To report our 11-year experience of Active Surveillance (AS) program focusing on modern transrectal ultrasound (TRUS)-based monitoring of targeted biopsy-proven cancer lesion.

Consecutive patients on AS, who had targeted biopsy-proven lesion followed by at least a repeat surveillance biopsy and three times TRUS monitoring of the identical visible lesion, were included.

Doppler grade of blood flow signal within the lesion was classified from grade 0 to 3. Biopsy-proven progression was defined as upgrade of Gleason score or 25 % or greater increase in cancer core involvement.

Fifty patients were included in this study. Clinical variables (median) included age (61 years), clinical stage (T1c, 42;T2, 8), PSA (4. 6 ng/ml), and Gleason score (3 + 3, n = 41;3 + 4, n = 9). Of the 50 patients, 34 demonstrated pathological progression at a median follow-up of 4. 4 years. In comparing between without (n = 16) and with (n = 34) pathological progression, there were significant differences in cancer core involvement at entry (p = 0. 003), the major axis diameter (p = 0. 001) and minor axis diameter (p = 0. 001) of the visible lesion at entry, increase in the major axis diameter (p = 0. 005) and minor axis diameter (p = 0. 013), and upgrade of Doppler grade (p < 0. 0001). In multivariate analysis for predicting pathological progression, the increase (≥25 %) in diameter of biopsy-proven lesion (hazard ratio, 15. 314; p = 0. 023) and upgrade of Doppler grade (hazard ratio, 37. 409; p = 0. 019) were significant risk factors.

Longitudinal monitoring of the TRUS-visible biopsy-proven cancer provides a new opportunity to perform per-lesion-based AS. The increase in diameter and upgrade of Doppler grade of the lesion were significant risk factors for biopsy-proven progression on AS.

World journal of urology. 2015 Jun 21 [Epub ahead of print]

Sunao Shoji, Osamu Ukimura, Andre Luis de Castro Abreu, Arnaud Marien, Toru Matsugasumi, Duke Bahn, Inderbir S Gill

Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.