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Published on: April 9, 2019
MRI-derived PRECISE score for predicting pathologically-confirmed progression in prostate cancer patients on active
Filippo Carletti1, Filippo Crimì2, Gianmarco Randazzo1
1Department of Surgery, Oncology and Gastroenterology, Urology Clinic, University of Padova, Padova, Italy.
Introduction:
The utilization of magnetic resonance imaging (MRI) in active surveillance (AS) of prostate cancer (PCa) remains a topic of debate. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system is used to evaluate the progression of MRI lesions in men undergoing AS.This study aims to evaluate the predictive capacity of the PRECISE score in monitoring PCa patients on AS.
Material And Methods:
A cohort of 63 men enrolled in an AS program between 2017 and 2021 was analyzed. Sequential MRIs within the AS protocol were assessed by a specialized radiologist using the PRECISE score. Data on biopsy outcomes, pathological progression, and treatment progression were documented. The relationship between progression and the PRECISE score was examined. Univariate logistic and Cox regression analyses were conducted to determine the baseline clinical and mpMRI parameters associated with disease progression.
Results:
The cohort exhibited ISUP progression and biopsy progression rates of 27.6% (16/63) and 48.3% (28/63), respectively. At the second MRI, a PRECISE score exceeding 3 was observed in 31 patients (53.4%), with 25 patients (43.1%) showing new lesions. Overall, 23 patients (39.7%) underwent active treatment during a median follow-up of 117 months. The PRECISE score emerged as the sole predictor, in univariate analysis, of ISUP progression (OR: 3.2, IQR: 1.1-9.7, p = 0.04), biopsy progression (OR: 3.2, IQR: 1.1-9.7, p = 0.03), and active treatment (HR: 1.1, IQR: 1.0-1.6, p = 0.05).
Conclusions:
The PRECISE scoring system facilitates the identification of patients at risk of ISUP and biopsy progression within an AS protocol utilizing mpMRI. These findings underscore the significance of mpMRI in AS.
Insights
The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) score effectively predicts disease progression in men with prostate cancer undergoing active surveillance. This magnetic resonance imaging (MRI) tool aids in identifying patients needing treatment, enhancing prostate cancer monitoring.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Active surveillance (AS) for prostate cancer (PCa) relies on monitoring disease progression.
- Magnetic resonance imaging (MRI) plays a role in AS, but its predictive capacity needs further evaluation.
- The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system assesses MRI lesion changes.
Purpose of the Study:
- To evaluate the predictive capability of the PRECISE score for monitoring PCa patients on AS.
- To determine if the PRECISE score can identify patients at risk of disease progression.
Main Methods:
- A cohort of 63 men in an AS program (2017-2021) was analyzed.
- Sequential MRIs were assessed by a radiologist using the PRECISE score.
- Logistic and Cox regression analyses examined associations between PRECISE scores and progression outcomes.
Main Results:
- 27.6% of patients showed ISUP progression and 48.3% showed biopsy progression.
- A PRECISE score >3 was associated with increased risk of ISUP progression (OR: 3.2), biopsy progression (OR: 3.2), and active treatment (HR: 1.1).
- The PRECISE score was the sole univariate predictor for ISUP progression, biopsy progression, and active treatment.
Conclusions:
- The PRECISE scoring system aids in identifying patients at risk of progression during AS for PCa.
- mpMRI, assessed by the PRECISE score, is significant for monitoring prostate cancer patients on active surveillance.
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