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Area of Science:

  • Radiology
  • Oncology
  • Urology

Background:

  • Active surveillance (AS) is a management option for low- to intermediate-risk prostate cancer, deferring immediate treatment.
  • Serial magnetic resonance imaging (MRI) aids in patient selection and noninvasive monitoring of tumor progression during AS.
  • Standardization of MRI interpretation is crucial for consistent patient management.

Purpose of the Study:

  • To standardize MRI interpretation for prostate cancer patients on AS using the PRECISE scoring system.
  • To discuss optimal methods for measuring tumor size changes over time.
  • To define criteria for clinically meaningful progression and guide treatment initiation.

Main Methods:

  • Utilized routine MRI at entry and during AS over 20 years in a tertiary referral center.
  • Applied the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system (1-5 scale).
  • Discussed various tumor size measurement techniques (one/two-axis, ellipsoid formula, planimetry), favoring routine volume measurement by a single observer.

Main Results:

  • The PRECISE system categorizes radiologic change as regression (1-2), stability (3), or progression (4-5).
  • Established methods for optimizing MRI intervals based on risk categories.
  • Defined size change and MRI appearance indicative of clinically significant progression.

Conclusions:

  • Standardized MRI interpretation via PRECISE scoring enhances AS patient management.
  • Routine tumor volume measurement by a single observer is favored for tracking progression.
  • Optimized MRI protocols and clear progression criteria facilitate timely treatment decisions in prostate cancer AS.