European urology oncology · 2025
Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Sushentsev Nikita, Li Irene G, Xu George, Warren Anne Y, Hsu Celeste Y, Baxter Madison, Panchal Dev, Kastner Christof, Fernando Sean, Pazukhina Ekaterina, Blyuss Oleg, Zaikin Alexey, Shabaik Ahmed, Dale Anders M, Liss Michael, Barrett Tristan, Seibert Tyler M
Аннотация
BACKGROUND AND OBJECTIVE: Magnetic resonance imaging (MRI)-driven active surveillance (AS) is increasingly used for management of prostate cancer (PC). The aim of our study was to determine the oncological safety of contemporary MRI-driven AS and identify patients at higher risk of AS failure.
METHODS: This retrospective cohort study included AS patients with MRI-localised PC from three US and UK centres. The primary outcome was AS failure, which was defined as a composite of PC-specific mortality, metastasis, progression to grade group (GG) ≥4, or post-treatment biochemical recurrence. The secondary outcome was disease progression, defined as histological progression to GG 3 or progression to locally advanced disease. Hazard ratios (HRs) were estimated using multivariable Cox models, and multiplicity-adjusted log-rank tests were applied to compare event-free survival across subgroups.
KEY FINDINGS AND LIMITATIONS: The study cohort comprised 719 patients with median follow-up of 5.2 yr. Of these patients, 629 (87%) had stable disease; 36 (5%) experienced AS failure, including eight (1%) cases of metastasis and no PC-related deaths; and 54 (8%) had disease progression. Cribriform GG 2 histology was the strongest predictor of AS failure (HR 12.7, 95% confidence interval [CI] 4.8-33.6; p < 0.001), followed by tumour MRI visibility (HR 5.0, 95% CI 1.5-16.5; p = 0.009) and noncribriform GG 2 histology (HR 3.4, 95% CI 1.6-7.0; p = 0.001). Event-free survival was comparable for MRI-invisible noncribriform GG 2 and all GG 1 tumours (adjusted p > 0.05 for both outcomes). The study is limited by its retrospective design.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Contemporary MRI-based AS for PC is safe for suitable patients, including men with noncribriform GG 2 tumours, particularly those that are MRI-invisible. Conversely, patients with cribriform GG 2 disease are at higher risk of AS failure, so consideration of upfront treatment is warranted for this subgroup.
METHODS: This retrospective cohort study included AS patients with MRI-localised PC from three US and UK centres. The primary outcome was AS failure, which was defined as a composite of PC-specific mortality, metastasis, progression to grade group (GG) ≥4, or post-treatment biochemical recurrence. The secondary outcome was disease progression, defined as histological progression to GG 3 or progression to locally advanced disease. Hazard ratios (HRs) were estimated using multivariable Cox models, and multiplicity-adjusted log-rank tests were applied to compare event-free survival across subgroups.
KEY FINDINGS AND LIMITATIONS: The study cohort comprised 719 patients with median follow-up of 5.2 yr. Of these patients, 629 (87%) had stable disease; 36 (5%) experienced AS failure, including eight (1%) cases of metastasis and no PC-related deaths; and 54 (8%) had disease progression. Cribriform GG 2 histology was the strongest predictor of AS failure (HR 12.7, 95% confidence interval [CI] 4.8-33.6; p < 0.001), followed by tumour MRI visibility (HR 5.0, 95% CI 1.5-16.5; p = 0.009) and noncribriform GG 2 histology (HR 3.4, 95% CI 1.6-7.0; p = 0.001). Event-free survival was comparable for MRI-invisible noncribriform GG 2 and all GG 1 tumours (adjusted p > 0.05 for both outcomes). The study is limited by its retrospective design.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Contemporary MRI-based AS for PC is safe for suitable patients, including men with noncribriform GG 2 tumours, particularly those that are MRI-invisible. Conversely, patients with cribriform GG 2 disease are at higher risk of AS failure, so consideration of upfront treatment is warranted for this subgroup.