Evolution of Active Surveillance of Prostate Cancer: Impact of MRI, MRI-guided Biopsy and Focal Therapy
Menée à partir de données portant sur 869 patients atteints d'un cancer de la prostate de grade compris entre 1 et 2 (durée médiane de suivi : 4,1 ans), cette étude évalue la pertinence d'une biopsie guidée par IRM pour déterminer la durée de la surveillance active et éviter des biopsies de suivi puis examine l'intérêt d'une thérapie localisée pour allonger la durée de la surveillance active
Purpose: We aimed to determine if, using baseline MRI-guided biopsy (MRGB), durability of active surveillance (AS) could be pre-determined, follow-up biopsies avoided, and if by incorporating focal therapy (FT), AS extended.
Materials and Methods: A cohort of 869 men in the UCLA protocol study of AS (2010-2022) was analyzed. Inclusion criteria were baseline MRI-guided biopsy (MRGB) showing Grade Group (GG) ≤ 2 and >1 year enrollment. After 2016, FT was offered to men with GG2 and those progressing to GG3.
Results: The 869 men accrued 3500 patient-years of follow-up (median follow-up 4.1 years). At baseline, men were GG1 (505), GG2 (174), and ‘GG0’ (190), the latter describing those with prior diagnostic GG1 or 2, but negative baseline MRGB. Overall, progression to ≥ GG3 among the 664 with serial MRGB was 7% for GG0, 19% for GG1, and 34% for GG2. During follow-up, absence of progression (negative predictive value, NPV) was correctly identified by MRI in nearly 95% of men with baseline GG0; 90% of men with GG1; and 70% of men with GG2. FT was performed in 99/393 eligible men (25%); among them, five-year probability of RP/RT-free survival was 84% compared to 46% in the no-FT group (p<0.01).
Conclusions and Relevance: Durability of AS may be linked to baseline MRGB. In men starting AS with MRGB and low-risk prostate cancer, subsequent MRI exhibits high NPV, indicating routine follow-up biopsy is avoidable. In some men, FT may allow extension of AS and deferral of surgery or radiation.
The Journal of Urology , article en libre accès 2025