European urology open science · 2026
Comparative assessment of METastasis Reporting and Data System for Prostate Cancer versus Prostate Cancer Clinical Trials Working Group 3 Criteria in assessing treatment response in patients with metastatic castration-resistant prostate cancer.
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Russo Luca, Longoria Ossian, Bottazzi Silvia, Porta Nuria, Biscombe Katie, Withey Samuel J, Avesani Giacomo, Abramovicz Katarzyna, Blackledge Matthew D, D'Erme Luca, Russell-Rose Katie, Taha Tarek, Sharp Adam, Paschalis Alec, Sala Evis, Koh Dow-Mu, de Bono Johann, Tunariu Nina
Аннотация
BACKGROUND: Unequivocal clinical progression without radiological progression according to Prostate Cancer Clinical Trials Working Group 3 (PCWG3) criteria is recognised in metastatic castration-resistant prostate cancer (mCRPC), reflecting limitations of bone scintigraphy in distinguishing an osteoblastic progression from an osteoblastic flare.
OBJECTIVE: To compare the METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P) on whole-body magnetic resonance imaging (WBMRI) with PCWG3 imaging criteria, the current gold standard.
DESIGN SETTING AND PARTICIPANTS: A retrospective cohort of 184 patients with mCRPC who underwent paired WBMRI and conventional imaging during therapy.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was concordance (percentage agreement [%A]) between MET-RADS-P and PCWG3 for overall, bone-only, and soft-tissue-only responses. Secondary endpoints were radiologic progression-free survival (rPFS) by each system and overall survival (OS) according to early (≤12 wk) MET-RADS-P response.
RESULTS AND LIMITATIONS: We evaluated 467 paired assessments in 184 patients. Overall concordance between PCWG3 and MET-RADS-P was moderate (%A = 64.5%; 95% confidence interval [CI] = 59.8-68.7), and it was high in soft tissue (%A = 88.8%; 95% CI = 85.7-91.6) and limited in bone (%A = 44.4%; 95% CI = 39.8-48.9). MET-RADS-P labelled progression more often than PCWG3 overall (66.6% vs 39.7%) and in bone (61.2% vs 20.3%). Median rPFS was shorter by MET-RADS-P than by PCWG3 (2.7 vs 4.2 mo; p < 0.001). Early MET-RADS-P progression was significantly associated with worse OS (adjusted hazard ratio [HR] = 4.75; 95% CI = 2.1-10.7; p < 0.001). Limitations include retrospective single-centre design, trial-based expert-centre cohort, and limited follow-up.
CONCLUSIONS: Concordance between PCWG3 and MET-RADS-P was moderate overall and limited in bone. Earlier MET-RADS-P-defined progression may identify aggressive disease and allow a prompt change in therapy before clinical deterioration limits subsequent treatment options. Prospective validation is warranted.
OBJECTIVE: To compare the METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P) on whole-body magnetic resonance imaging (WBMRI) with PCWG3 imaging criteria, the current gold standard.
DESIGN SETTING AND PARTICIPANTS: A retrospective cohort of 184 patients with mCRPC who underwent paired WBMRI and conventional imaging during therapy.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was concordance (percentage agreement [%A]) between MET-RADS-P and PCWG3 for overall, bone-only, and soft-tissue-only responses. Secondary endpoints were radiologic progression-free survival (rPFS) by each system and overall survival (OS) according to early (≤12 wk) MET-RADS-P response.
RESULTS AND LIMITATIONS: We evaluated 467 paired assessments in 184 patients. Overall concordance between PCWG3 and MET-RADS-P was moderate (%A = 64.5%; 95% confidence interval [CI] = 59.8-68.7), and it was high in soft tissue (%A = 88.8%; 95% CI = 85.7-91.6) and limited in bone (%A = 44.4%; 95% CI = 39.8-48.9). MET-RADS-P labelled progression more often than PCWG3 overall (66.6% vs 39.7%) and in bone (61.2% vs 20.3%). Median rPFS was shorter by MET-RADS-P than by PCWG3 (2.7 vs 4.2 mo; p < 0.001). Early MET-RADS-P progression was significantly associated with worse OS (adjusted hazard ratio [HR] = 4.75; 95% CI = 2.1-10.7; p < 0.001). Limitations include retrospective single-centre design, trial-based expert-centre cohort, and limited follow-up.
CONCLUSIONS: Concordance between PCWG3 and MET-RADS-P was moderate overall and limited in bone. Earlier MET-RADS-P-defined progression may identify aggressive disease and allow a prompt change in therapy before clinical deterioration limits subsequent treatment options. Prospective validation is warranted.