MP38-20 MRI-GUIDED ACTIVE SURVEILLANCE WITHOUT ANNUAL RE-BIOPSY IN PATIENTS WITH ISUP 1 AND 2 PROSTATE CANCER: THE PROSPECTIVE PROMM-AS STUDY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP38-20 MRI-GUIDED ACTIVE SURVEILLANCE WITHOUT ANNUAL RE-BIOPSY IN PATIENTS WITH ISUP 1 AND 2 PROSTATE CANCER: THE PROSPECTIVE PROMM-AS STUDY Jan Philipp Radtke, Birte Valentin, Christian Arsov, Tim Ullrich, Rouvier Al-Monajjed, Matthias Boschheidgen, Markus Giessing, Cristina Lopez-Cotarelo, Gerald Antoch, and Lars Schimmöller Jan Philipp RadtkeJan Philipp Radtke More articles by this author , Birte ValentinBirte Valentin More articles by this author , Christian ArsovChristian Arsov More articles by this author , Tim UllrichTim Ullrich More articles by this author , Rouvier Al-MonajjedRouvier Al-Monajjed More articles by this author , Matthias BoschheidgenMatthias Boschheidgen More articles by this author , Markus GiessingMarkus Giessing More articles by this author , Cristina Lopez-CotareloCristina Lopez-Cotarelo More articles by this author , Gerald AntochGerald Antoch More articles by this author , and Lars SchimmöllerLars Schimmöller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is evidence that multiparametric magnetic resonance imaging (mpMRI) may avoid repeat prostate biopsies in monitoring of patients during active surveillance (AS) for prostate cancer (PC).To assess the ability of mpMRI to risk stratify men on AS, including ISUP grade group (GG) 1 and 2 PC to reduce guideline-mandated biopsy, and to predict ISUP GG upgrading. METHODS: Prospective 2-year single-center outcome of an mpMRI-guided AS protocol (PROMM-AS). 12 months after AS inclusion with MRI/TRUS fusion-guided biopsy, all men underwent mpMRI. In case of stable mpMRI according to PRECISE criteria, re-biopsy was deferred and follow-up mpMRI after 24 months performed. In case of mpMRI progression or at the end of study, follow-up MRI/TRUS fusion-guided biopsy was indicated. Primary endpoint was a reduction of histopathological AS disqualification from previous published 25% to 15%. A sample size of in total 150 men was calculated to achieve 80% power to detect this rate difference. We calculated sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for ISUP GG upgrading on MRI and performed regression analyses. RESULTS: In total, 101 men (60 with GG1 and 41 with GG2 PC) were available for analysis. Histopathological progression occurred in total in 29 men. Thus, the primary endpoint could not be reached and we performed an interim-analysis. In the GG1 subgroup 18 men had progression (30%), whereas 11 men progressed in GG2 subgroup (27%). Sensitivity, specificity, PPV and NPV for PRECISE was 94%, 64%, 81% and 88% in the GG1 subgroup and 91%, 50%, 91% and 50% in GG2 subgroup. On regression analysis, higher PRECISE scores (4-5), initial PI-RADS, PSA, age and prostate volume were significant predictors of histological progression in ISUP GG1 and higher PRECISE score, initial PI-RADS and previous negative biopsy in ISUP GG2 PC. CONCLUSIONS: MRI-guided monitoring of men on AS including PRECISE criteria avoids unnecessary follow-up biopsies in 88% of men with ISUP GG1 and sufficiently predicts GG upgrading over a follow-up period of two years in both ISUP GG1 and GG2. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e532 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jan Philipp Radtke More articles by this author Birte Valentin More articles by this author Christian Arsov More articles by this author Tim Ullrich More articles by this author Rouvier Al-Monajjed More articles by this author Matthias Boschheidgen More articles by this author Markus Giessing More articles by this author Cristina Lopez-Cotarelo More articles by this author Gerald Antoch More articles by this author Lars Schimmöller More articles by this author Expand All Advertisement PDF downloadLoading ...