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Clinical Research

Confirmatory multiparametric magnetic resonance imaging at recruitment confers prolonged stay in active surveillance and decreases the rate of upgrading at follow-up

Prostate Cancer and Prostatic Diseases volume 23, pages 94–101 (2020)Cite this article

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A Correction to this article was published on 13 December 2019

This article has been updated

Abstract

Background

To understand the value of multiparametric magnetic resonance imaging (mpMRI) and targeted biopsies at recruitment on active surveillance (AS) outcomes.

Materials and methods

This retrospective single-center study enrolled two cohorts of 206 and 310 patients in AS. The latter group was submitted to mpMRI and targeted biopsies at recruitment. Kaplan–meier curves quantified progression-free survival (PFS) and Bioptic-PFS (B-PFS: no upgrading or >3 positive cores) in the two cohorts. Cox-regression analyses tested independent predictors of PFS and B-PFS. In patients submitted to radical prostatectomy (RP) after AS, significant cancer (csPCa) was defined as: GS ≥ 4 + 3 and/or pT ≥ 3a and/or pN+ . Logistic-regression analyses predicted csPCa at RP.

Results and limitations

Median time follow-up and median time of persistence in AS were 46 (24–70) and 36 (23–58) months, respectively. Patients submitted to mpMRI at AS begin, showed greater PFS at 1- (98% vs. 91%), 3- (80% vs. 57%), and 5-years (70% vs. 35%) follow-up, respectively (all p < 0.01). At Cox-regression analysis only confirmatory mpMRI± targeted biopsy (HR: 0.3; 95% CI 0.2–0.5; p < 0.01) at AS begin was an independent predictor of PFS. Globally, 50 (16%) vs. 128 (62%) and 26 (8.5%) vs. 64 (31%) [all p < 0.01] men in the two groups experienced any-cause and bioptic AS discontinuation, respectively. Patients submitted to confirmatory mpMRI experienced greater 1-(98% vs. 93%), 3-(90% vs. 75%), and 5-years (83% vs. 56%) B-PFS, respectively (all p < 0.01). At Cox-regression analysis, mpMRI±-targeted biopsy at AS begin was associated with B-PFS (HR: 0.3; 95% CI 0.2–0.6; p < 0.01). No differences were recorded in csPCa rates between the two groups (22% vs. 28%; p = 0.47). Limitations of the study are the single-center retrospective nature and the absence of long-term follow-up.

Conclusions

Confirmatory mpMRI±-targeted biopsies are associated with higher PFS and B-PFS during AS. However, a non-negligible percentage of patients experience csPCa after switching to active treatment.

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Authors and Affiliations

  1. Department of Urology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, Milan, Italy

    Stefano Luzzago, Michele Catellani, Ettore Di Trapani, Gabriele Cozzi, Francesco A. Mistretta, Roberto Bianchi, Andrea Conti, Nicolò Piacentini, Matteo Ferro, Deliu-Victor Matei, Gennaro Musi & Ottavio de Cobelli

  2. Università degli Studi di Milano, Milan, Italy

    Stefano Luzzago, Francesco A. Mistretta, Andrea Conti, Eleonora Ancona & Nicolò Piacentini

  3. Department of Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, Milan, Italy

    Paola Pricolo, Sarah Alessi & Giuseppe Petralia

  4. Department of Pathology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, Milan, Italy

    Giuseppe Renne

  5. Università degli Studi di Milano, Department of Oncology and Hematology-Oncology, Milan, Italy

    Barbara Alicja Jereczek-Fossa & Ottavio de Cobelli

  6. Department of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, Milan, Italy

    Barbara Alicja Jereczek-Fossa

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  1. Stefano Luzzago
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Correspondence to Stefano Luzzago.

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Luzzago, S., Catellani, M., Di Trapani, E. et al. Confirmatory multiparametric magnetic resonance imaging at recruitment confers prolonged stay in active surveillance and decreases the rate of upgrading at follow-up. Prostate Cancer Prostatic Dis 23, 94–101 (2020). https://doi.org/10.1038/s41391-019-0160-3

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