Prostate Cancer Patients Under Active Surveillance with a Suspicious Magnetic Resonance Imaging Finding Are at Increased Risk of Needing Treatment: Results of the Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium
Jonathan Olivier, Weiyu Li, Daan Nieboer, Jozien Helleman, Monique J. Roobol, Vincent J. Gnanapragasam, Mark Frydenberg, Mikio Sugimoto, Peter Carroll, Todd M. Morgan, R. Valdagni, J. Rubio‐Briones, Grégoire Robert, Phillip D. Stricker, Andrew Hayen, Ivo G. Schoots, Masoom A. Haider, Caroline M. Moore, Brian T. Denton, Arnauld Villers, Bruce J. Trock, Behfar Ehdaie, Peter Carroll, Christopher P. Filson, Christopher J. Logothetis, Todd M. Morgan, Laurence Klotz, Tom Pickles, Eric Hyndman, Caroline M. Moore, Vincent J. Gnanapragasam, Mieke Van Hemelrijck, Prokar Dasgupta, Chris H. Bangma, Monique Roobol, Arnauld Villers, Grégoire Robert, Axel Semjonow, Antti Rannikko, R. Valdagni, Antoinette S. Perry, Jonas Hugosson, J. Rubio‐Briones, Anders Bjartell, Lukas Hefermehl, Lee Lui Shiong, Mark Frydenberg, Phillip D. Stricker, Mikio Sugimoto, Byung Ha Chung, Theodorus van der Kwast, Tim Hulsen, Wim van der Linden, Boris Ruwe, Peter van Hooft, Ewout W. Steyerberg, Daan Nieboer, Brian T. Denton, Andrew Hayen, Paul C. Boutros, Wei Guo, Nicole Benfante, Janet E. Cowan, Dattatraya Patil, Lauren Park, Stephanie Ferrante, Alexandre Mamedov, Vincent Lapointe, Trafford Crump, Vasilis Stavrinides, Jenna Kimberly-Duffell, Aida Santaolalla, Daan Nieboer, Jonathan Olivier, T. Rancati, Helén Ahlgren, Juanma Mascarós, Annica Löfgren, Kurt Lehmann, Catherine Han Lin, Thomas W. Cusick, Hiromi Hirama, Kwang Suk Lee, Guido Jenster, Anssi Auvinen, Anders Bjartell, Masoom A. Haider, Kees van Bochove, Michelle M. Kouspou, Kellie Paich, Chris H. Bangma, Monique Roobol, Jozien Helleman
Abstract
BACKGROUND: The inclusion criterion for active surveillance (AS) is low- or intermediate-risk prostate cancer. The predictive value of the presence of a suspicious lesion at magnetic resonance imaging (MRI) at the time of inclusion is insufficiently known. OBJECTIVE: To evaluate the percentage of patients needing active treatment stratified by the presence or absence of a suspicious lesion at baseline MRI. DESIGN SETTING AND PARTICIPANTS: A retrospective analysis of the data from the multicentric AS GAP3 Consortium database was conducted. The inclusion criteria were men with grade group (GG) 1 or GG 2 prostate cancer combined with prostate-specific antigen <20 ng/ml. We selected a subgroup of patients who had MRI at baseline and for whom MRI results and targeted biopsies were used for AS eligibility. Suspicious MRI was defined as an MRI lesion with Prostate Imaging Reporting and Data System (PI-RADS)/Likert ≥3 and for which targeted biopsies did not exclude the patient for AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was treatment free survival (FS). The secondary outcomes were histological GG progression FS and continuation of AS (discontinuation FS). RESULTS AND LIMITATIONS: < 0.001) were significantly higher in the suspicious MRI group than in the nonsuspicious MRI group. CONCLUSIONS: The risks of switching to treatment, histological progression, and AS discontinuation are higher in cases of suspicious MRI at inclusion. PATIENT SUMMARY: Among men with low- or intermediate-risk prostate cancer who choose active surveillance, those with suspicious magnetic resonance imaging (MRI) at the time of inclusion in active surveillance are more likely to show switch to treatment than men with nonsuspicious MRI.