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Introducing mpMRI into contemporary UK active surveillance for localised prostate cancer
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
802
Introducing mpMRI into contemporary UK active surveillance for localised prostate cancer Eur Urol Suppl 2017; 16(3);e1397
Bryant R.1, Yang B.1, Philippou Y.1, Lam K.1, Obiakor M.1, Ayers J.B.1, Gleeson F.2, Macpherson R.2, Verrill C.3, Roberts I.3, Leslie T.1, Crew J.1, Sooriakumaran P.1, Hamdy F.1, Brewster S.1 1
Oxford University Hospitals Nhs Foundation Trust, Dept. of Urology, Oxford, United Kingdom, 2Oxford University Hospitals Nhs Foundation Trust, Dept. of Radiology, Oxford, United Kingdom, 3Oxford University Hospitals Nhs Foundation Trust, Dept. of Pathology, Oxford, United Kingdom INTRODUCTION & OBJECTIVES: Active surveillance (AS) of localized prostate cancer (PCa) in the UK involved protocol-driven (P) transrectal repeat biopsies (RB) plus serial digital rectal examination & PSAtesting, until NICE 2014 guidelines recommended multi-parametric magnetic resonance imaging (mpMRI) should drive RB where needed or replace P-RB. Interrogating our AS follow-up (F/U) data, we hypothesized that mpMRI reduces the number of RB required to drive therapeutic intervention (TI). MATERIAL & METHODS: 445/461 (97%) AS patients had complete F/U data. Cohort features at diagnosis include median age 68.9 years (interquartile range IQR 63.7-74.8), median PSA 7.2ng/mL (IQR 5.6-9.6), median PSAD 0.11 (IQR 0.08-0.18), ≤cT1c in 80%, 54% unilateral Gleason 3+3, 23% unilateral 3+4, 2% unilateral ≥4+3, 18% bilateral ≥3+3, and median Charlson Comorbidity score 3.1 (IQR 2.5-4.2). We examined the drivers for TI and compared the utility of mpMRI prior to potential RB in AS. RESULTS: 132/445 (30%) patients underwent TI (59% external beam radiotherapy/brachytherapy, 22% radical surgery, 19% other) over a median AS (inter-quartile range IQR) F/U of 2.4 (1.2-3.73) years (maximum F/U 11.3 years). Median (IQR) time to TI was 1.55 (0.71-2.4) years. Reasons for TI included rising PSA, patient choice, mpMRI abnormality alone and/or RB Gleason upgrading. Where TI was driven by RB, 43/71 (61%) had undergone mpMRI, and 39% had P-RB without mpMRI. 49/97 (51%) demonstrated upgrading on RB following mpMRI versus 38/115 (33%) for P-RB without mpMRI. Time to TI was similar for those undergoing RB following mpMRI versus P-RB without mpMRI (P=0.877). Of those upgraded at RB, the number of RB procedures needed to upgrade one patient was 1.9 if prior mpMRI was used versus 3.3 for P-RB alone. CONCLUSIONS: In this UK cancer centre AS cohort, replacement of P-RB with mpMRI +/- RB where indicated, benefitted patients by reducing the number of invasive interventions needed to identify disease progression (characterized by Gleason upgrade), leading to treatment intervention.
Eur Urol Suppl 2017; 16(3);e1397 Powered by TCPDF (www.tcpdf.org)
802
Introducing mpMRI into contemporary UK active surveillance for localised prostate cancer Eur Urol Suppl 2017; 16(3);e1397
Bryant R.1, Yang B.1, Philippou Y.1, Lam K.1, Obiakor M.1, Ayers J.B.1, Gleeson F.2, Macpherson R.2, Verrill C.3, Roberts I.3, Leslie T.1, Crew J.1, Sooriakumaran P.1, Hamdy F.1, Brewster S.1 1
Oxford University Hospitals Nhs Foundation Trust, Dept. of Urology, Oxford, United Kingdom, 2Oxford University Hospitals Nhs Foundation Trust, Dept. of Radiology, Oxford, United Kingdom, 3Oxford University Hospitals Nhs Foundation Trust, Dept. of Pathology, Oxford, United Kingdom INTRODUCTION & OBJECTIVES: Active surveillance (AS) of localized prostate cancer (PCa) in the UK involved protocol-driven (P) transrectal repeat biopsies (RB) plus serial digital rectal examination & PSAtesting, until NICE 2014 guidelines recommended multi-parametric magnetic resonance imaging (mpMRI) should drive RB where needed or replace P-RB. Interrogating our AS follow-up (F/U) data, we hypothesized that mpMRI reduces the number of RB required to drive therapeutic intervention (TI). MATERIAL & METHODS: 445/461 (97%) AS patients had complete F/U data. Cohort features at diagnosis include median age 68.9 years (interquartile range IQR 63.7-74.8), median PSA 7.2ng/mL (IQR 5.6-9.6), median PSAD 0.11 (IQR 0.08-0.18), ≤cT1c in 80%, 54% unilateral Gleason 3+3, 23% unilateral 3+4, 2% unilateral ≥4+3, 18% bilateral ≥3+3, and median Charlson Comorbidity score 3.1 (IQR 2.5-4.2). We examined the drivers for TI and compared the utility of mpMRI prior to potential RB in AS. RESULTS: 132/445 (30%) patients underwent TI (59% external beam radiotherapy/brachytherapy, 22% radical surgery, 19% other) over a median AS (inter-quartile range IQR) F/U of 2.4 (1.2-3.73) years (maximum F/U 11.3 years). Median (IQR) time to TI was 1.55 (0.71-2.4) years. Reasons for TI included rising PSA, patient choice, mpMRI abnormality alone and/or RB Gleason upgrading. Where TI was driven by RB, 43/71 (61%) had undergone mpMRI, and 39% had P-RB without mpMRI. 49/97 (51%) demonstrated upgrading on RB following mpMRI versus 38/115 (33%) for P-RB without mpMRI. Time to TI was similar for those undergoing RB following mpMRI versus P-RB without mpMRI (P=0.877). Of those upgraded at RB, the number of RB procedures needed to upgrade one patient was 1.9 if prior mpMRI was used versus 3.3 for P-RB alone. CONCLUSIONS: In this UK cancer centre AS cohort, replacement of P-RB with mpMRI +/- RB where indicated, benefitted patients by reducing the number of invasive interventions needed to identify disease progression (characterized by Gleason upgrade), leading to treatment intervention.
Eur Urol Suppl 2017; 16(3);e1397 Powered by TCPDF (www.tcpdf.org)