Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer: The PRECISE Recommendations-A Report of a European School of Oncology Task Force

Published data on prostate magnetic resonance imaging (MRI) during follow-up of men on active surveillance are lacking. Current guidelines for prostate MRI reporting concentrate on prostate cancer (PCa) detection and staging. A standardised approach to prostate MRI reporting for active surveillance will facilitate the robust collection of evidence in this newly developing area.

To develop preliminary recommendations for reporting of individual MRI studies in men on active surveillance and for researchers reporting the outcomes of cohorts of men having MRI on active surveillance.

The RAND/UCLA Appropriateness Method was used. Experts in urology, radiology, and radiation oncology developed a set of 394 statements relevant to prostate MRI reporting in men on active surveillance for PCa. Each statement was scored for agreement on a 9-point scale by each panellist prior to a panel meeting. Each statement was discussed and rescored at the meeting.

Measures of agreement and consensus were calculated for each statement. The most important statements, derived from both group discussion and scores of agreement and consensus, were used to create the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) checklist and case report form.

Key recommendations include reporting the index lesion size using absolute values at baseline and at each subsequent MRI. Radiologists should assess the likelihood of true change over time (ie, change in size or change in lesion characteristics on one or more sequences) on a 1-5 scale. A checklist of items for reporting a cohort of men on active surveillance was developed. These items were developed based on expert consensus in many areas in which data are lacking, and they are expected to develop and change as evidence is accrued.

The PRECISE recommendations are designed to facilitate the development of a robust evidence database for documenting changes in prostate MRI findings over time of men on active surveillance. If used, they will facilitate data collection to distinguish measurement error and natural variability in MRI appearances from true radiologic progression.

Few published reports are available on how to use and interpret magnetic resonance imaging for men on active surveillance for prostate cancer. The PRECISE panel recommends that data should be collected in a standardised manner so that natural variation in the appearance and measurement of cancer over time can be distinguished from changes indicating significant tumour progression.

European urology. 2016 Jun 24 [Epub ahead of print]

Caroline M Moore, Francesco Giganti, Peter Albertsen, Clare Allen, Chris Bangma, Alberto Briganti, Peter Carroll, Masoom Haider, Veeru Kasivisvanathan, Alex Kirkham, Laurence Klotz, Adil Ouzzane, Anwar R Padhani, Valeria Panebianco, Peter Pinto, Philippe Puech, Antti Rannikko, Raphaele Renard-Penna, Karim Touijera, Baris Turkbey, Heinrik van Poppel, Riccardo Valdagni, Jochen Walz, Ivo Schoots

Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK. Electronic address: ., Department of Radiology, University College London Hospital Trust, London, UK; Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy., Division of Urology, University of Connecticut Health Center, Farmington, CT, USA., Department of Radiology, University College London Hospital Trust, London, UK., Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands., Department of Urology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy., Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA., Department of Medical Imaging, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada., Division of Surgical and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals Trust, London, UK., Department of Radiology, University College London Hospital Trust, London, UK., Department of Urology, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada., Department of Urology, CHU Lille, Université de Lille, Lille, France., Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK., Department of Radiological Sciences, Oncology and Pathology, Prostate Unit Diagnostic University of Rome, "La Sapienza", Rome, Italy., Urologic Oncology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA., Department of Radiology, CHU Lille, Université de Lille, Lille, France., Department of Urology, Helsinki University Central Hospital, Helsinki, Finland., Department of Radiology, Pitié-Salpetrière Hospital, AP-HP, UPMC Paris 06, Paris, France., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., Department of Urology, University Hospitals of KU Leuven, Leuven, Belgium., Radiation Oncology, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy; Diagnostic Imaging and Radiotherapy, Università degli Studi di Milano, Milan, Italy., Department of Urology, Institut Paoli-Calmettes, Marseille, France., Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.

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