Central European journal of urology · 2026
Results of radical prostatectomy and short-term follow-up of men with ISUP GG 1 and 2 prostate cancer who underwent magnetic resonance imaging-guided active surveillance.
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Busshoff Isabelle, Al-Monajjed Rouvier, Schimmöller Lars, Arsov Christian, Valentin Birte, Lakes Jale, Ullrich Tim, Hadaschik Boris A, Giganti Francesco, Giessing Markus, Rau Tilman T, Esposito Irene, Antoch Gerald, Albers Peter, Boschheidgen Matthias, Radtke Jan Philipp
Аннотация
INTRODUCTION: Multiparametric magnetic resonance imaging (mpMRI) reduces the need for repeat biopsies in prostate cancer (PC) patients under active surveillance (AS). The prospective PROMM-AS trial confirmed reliable prediction of upgrading in ISUP Grade Group (GG) 1-2 PC. We report outcomes of men from the PROMM-AS trial undergoing deferred radical prostatectomy (RP) after radiologic or histopathologic progression, including short-term oncological follow-up.
MATERIAL AND METHODS: The primary endpoint was biochemical recurrence (BCR; PSA ≥0.1 ng/ml). Secondary endpoints included adverse pathology (AP; ISUP GG ≥3 and/or ≥pT3 at RP), PSA level at 12 months, and metastases. Differences between ISUP GG were evaluated using Fisher's exact test. Sensitivity, specificity, positive and negative predictive value to predict BCR and AP were calculated. Regression analyses using MRI and clinical variables were performed to analyze predictors of BCR and AP.
RESULTS: Of 148 men, 28 (19%) - 10 GG1 and 18 GG2 - progressed (radiologic n=15, histopathologic n = 3, combined n = 10) and underwent RP within 24 months of trial duration. Median follow-up after RP was 24 months (IQR 15-38). Among 25 patients with ≥12 months follow-up, 92% achieved PSA <0.01 ng/ml at 12 months. BCR occurred in 4 patients (14%), AP in 9 (32%), and 1 patient (3.6%) developed pelvic lymph node metastasis. Gleason Pattern (GP) 4 at biopsy, PI-RADS, and PRECISE scores significantly predicted BCR, while GP4 percentage, percentage of positive cores and PI-RADS predicted AP.
CONCLUSIONS: These findings support the oncological safety of MRI-guided AS in terms of BCR and development of metastases in selected GG1/2 PC patients. However, the rate of AP needs to be acknowledged in patient counseling.
MATERIAL AND METHODS: The primary endpoint was biochemical recurrence (BCR; PSA ≥0.1 ng/ml). Secondary endpoints included adverse pathology (AP; ISUP GG ≥3 and/or ≥pT3 at RP), PSA level at 12 months, and metastases. Differences between ISUP GG were evaluated using Fisher's exact test. Sensitivity, specificity, positive and negative predictive value to predict BCR and AP were calculated. Regression analyses using MRI and clinical variables were performed to analyze predictors of BCR and AP.
RESULTS: Of 148 men, 28 (19%) - 10 GG1 and 18 GG2 - progressed (radiologic n=15, histopathologic n = 3, combined n = 10) and underwent RP within 24 months of trial duration. Median follow-up after RP was 24 months (IQR 15-38). Among 25 patients with ≥12 months follow-up, 92% achieved PSA <0.01 ng/ml at 12 months. BCR occurred in 4 patients (14%), AP in 9 (32%), and 1 patient (3.6%) developed pelvic lymph node metastasis. Gleason Pattern (GP) 4 at biopsy, PI-RADS, and PRECISE scores significantly predicted BCR, while GP4 percentage, percentage of positive cores and PI-RADS predicted AP.
CONCLUSIONS: These findings support the oncological safety of MRI-guided AS in terms of BCR and development of metastases in selected GG1/2 PC patients. However, the rate of AP needs to be acknowledged in patient counseling.