Nine-year Follow-up for a Study of Diffusion-weighted Magnetic Resonance Imaging in a Prospective Prostate Cancer Active Surveillance Cohort.

In active surveillance (AS) for prostate cancer there are few data on long-term outcomes associated with novel imaging markers.

To determine long-term outcomes with respect to the apparent diffusion coefficient (ADC) derived from diffusion-weighted magnetic resonance imaging (DW-MRI) in a prospective AS cohort.

Early results have already been published; we now present findings with long-term follow-up.

A subset of patients (n=86) underwent pre-enrolment DW-MRI in a prospective AS study between 2002 and 2006. Inclusion criteria were untreated prostate cancer, clinical T1/T2a/N0M0, Gleason ≤ 3+4, and prostate-specific antigen (PSA)

Men underwent baseline DW-MRI in addition to standard sequences. ADC was measured from the index lesion on T2-weighted images. To avoid influencing treatment decisions, DW-MRI sequence results were not available to the AS study investigators.

Baseline ADC was analysed with respect to time to radical treatment (TRT) and time to adverse histology (TAH). Kaplan-Meier analysis and univariate and multivariate regression analyses were performed.

The median follow-up was 9. 5 yr (interquartile range 7. 9-10. 0 yr). On univariate analysis, ADC below the median was associated with shorter TAH (hazard ratio [HR] 2. 13, 95% confidence interval [CI] 1. 17-3. 89; p

Long-term follow-up for this study provides strong evidence that ADC is a useful marker when selecting patients for AS. Routine DW-MRI is now being evaluated in our ongoing AS study for initial assessment and as an alternative to repeat biopsy.

Before entering a study of close monitoring for the initial management of prostate cancer, patients had a type of magnetic resonance imaging scan that looks at the movement of water within cancers. These scans may help in predicting whether patients should receive close monitoring or whether immediate treatment should be given.

European urology. 2015 Oct 16 [Epub ahead of print]

Daniel R Henderson, Nandita M de Souza, Karen Thomas, Sophie F Riches, Veronica A Morgan, Syed A Sohaib, David P Dearnaley, Christopher C Parker, Nicholas J van As

Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK. , Institute of Cancer Research, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK. , Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK. , Institute of Cancer Research, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK. , Institute of Cancer Research, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK. , Institute of Cancer Research, London, UK; Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK. , Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK. , Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK. , Academic Urology Unit, Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK.  

PubMed

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