Multicentre validation of the PRECISE scoring system for prostate MRI during active surveillance

Area of Science:

• Oncology
• Radiology
• Urology

Background:

• Active surveillance (AS) for prostate cancer requires reliable methods to monitor disease progression.
• The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system was developed to assess changes on serial MRI scans.
• PRECISE scores range from 1-2 (regression), 3 (stability), to 4-5 (progression).

Purpose of the Study:

• To evaluate the PRECISE score's effectiveness in predicting disease progression in a multicenter international cohort of prostate cancer patients undergoing active surveillance.
• To determine the diagnostic performance of the PRECISE score in identifying patients who require re-biopsy or treatment.

Main Methods:

• Retrospective analysis of data from 1667 patients across 22 international centers (December 2005 - July 2022).
• Inclusion criteria: at least two MRI scans (baseline and follow-up) and two biopsies (baseline and follow-up, post-second scan).
• Local radiologists assessed MRI scans using the PRECISE system; sensitivity, specificity, PPV, and NPV were calculated based on biopsy outcomes.

Main Results:

• Patients with PRECISE 4-5 scores had a 4.53-fold increased odds of biopsy progression (Grade Group ≥ 2) compared to those with PRECISE 1-3 scores (p < 0.001).
• For predicting progression using a PRECISE ≥ 4 cutoff on the first follow-up scan, sensitivity was 57%, specificity 79%, PPV 46%, and NPV 85%.
• A total of 1667 patients were included, with a median follow-up of 4 years; 24% experienced biopsy progression to Grade Group ≥ 2.

Conclusions:

• The PRECISE scoring system is a valuable tool for predicting prostate cancer progression in patients on active surveillance.
• Utilizing PRECISE scores can facilitate timely identification of patients needing re-biopsy or treatment.
• The PRECISE system may allow for the safe reduction of repeat biopsies in patients with stable MRI findings and PSA kinetics.