You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (PD62)1 Apr 2020PD62-02 DOES INCLUSION OF MRI IN ACTIVE SURVEILLANCE DECREASE THE RATE OF DISCONTINUATION? A REFLECTION OF THE USE OF MRI IN THE PRIAS STUDY Henk Luiting, Sebastiaan Remmers, Egbert Boevé, Rotterdam, Netherlands, Fabio Badenchini, Fabiana Zollo, Antti Rannikko, and Monique Roobol* Henk LuitingHenk Luiting More articles by this author , Sebastiaan RemmersSebastiaan Remmers More articles by this author , Egbert BoevéEgbert Boevé More articles by this author , Rotterdam, Netherlands Rotterdam, Netherlands More articles by this author , Fabio BadenchiniFabio Badenchini More articles by this author , Fabiana ZolloFabiana Zollo More articles by this author , Antti RannikkoAntti Rannikko More articles by this author , and Monique Roobol*Monique Roobol* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000979.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) aims to reduce overtreatment in patients with low-risk prostate cancer (PCa) and has, as initial treatment, excellent PCa-specific survival. The reduction of overtreatment is, however, limited due to a high rate of discontinuation (Drost et al. 2018). MRI enables a more accurate sampling of PCa. The use of MRI before inclusion in AS should, therefore, reduce lead to less discontinuation of AS. We compared the rate of discontinuation of men included with and without MRI information at inclusion. METHODS: The PRIAS study is a prospective observational study, providing data of real life clinical practice. Patients with Grade Group 1, included in the PRIAS study before the MRI era (Group A, n=500), included with an MRI within 6 months after inclusion (Group B, n = 248) and included with an MRI before inclusion (Group C, n = 250) were analyzed. The PRIAS MRI protocol advises MRI with possible target biopsies (TBx) 3 months after inclusion if MRI is not performed before inclusion, and at 1 year after inclusion with repeat systematic biopsies (SBx). Before the MRI era, SBx were advised 1 year after inclusion. Definite treatment in the PRIAS MRI protocol is advised if biopsies show Grade Group ≥ 2, and for patients before the MRI era if >2 SBx cores show PCa or if SBx show Grade Group ≥ 2. Cumulative incidence curves were used to estimate rates of AS discontinuation. RESULTS: In Group B, MRI showed a PIRADS 3,4 or 5 lesion in 49 (20%), 72 (29%) and 31 (13%) patients and in Group C in 58 (23%), 107 (42%) and 20 (8%) patients. At 15 months, 26% discontinued AS in Group A (21% due to progression), 28% in Group B (22% due to progression, 11% based solely on TBx) and 14% in Group C (7% due to progression, 2% based solely on TBx) (Figure 1). Median follow up in Group A was 45 months (IQR 15-85), 14 months (IQR 7-25) in Group B and 15 months (IQR 8-30) in Group C. CONCLUSIONS: The use of MRI before inclusion in AS reduces the rate of discontinuation after a period of 15 months from 26-28% to 14%. It is however remarkable that the reason of discontinuation is still in 50% of the cases related to progression. Considering the current excellent PCa-survival data in patients initially treated with AS, the question raises whether upfront MRI excludes patients potentially suitable for AS and as such actually contributes to overtreatment. Source of Funding: © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1285-e1286 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henk Luiting More articles by this author Sebastiaan Remmers More articles by this author Egbert Boevé More articles by this author Rotterdam, Netherlands More articles by this author Fabio Badenchini More articles by this author Fabiana Zollo More articles by this author Antti Rannikko More articles by this author Monique Roobol* More articles by this author Expand All Advertisement PDF downloadLoading ...