Visible disease at baseline accelerates time to exit from MRI-based active surveillance.
BAUS ePoster online library. Stavrinides V. 06/24/19; 259552; P5-8
Mr. Vasilis Stavrinides
Mr. Vasilis Stavrinides
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In MRI-based surveillance, the significance of visible disease at baseline is undefined. We present outcomes from the UCLH AS cohort and investigate associations with baseline imaging.
Outcomes were collected for 647 men (Aug 2004 - Dec 2017; Gleason 3+3 or low-volume 3+4, PSA<20, baseline mpMRI, >6 months of follow up; mean age: 61.8; median PSA: 6.4). Start time was the date of first MRI. Exit was defined as any treatment, transition to watchful waiting and/or progression to Gleason 4+3. Time-to-exit in men with a baseline Likert 1-3 (no lesion) versus those with Likert 4-5 (lesion) was compared.
Median f/u was 53 m (IQR 31.5-76). Overall, 172 men were treated (44 prostatectomy, 83 focal, 12 hormones, 17 radiotherapy [hormones in 12], 3 brachytherapy) and 14 transitioned to WW. One patient was treated due to anxiety. Progression on biopsy was observed in 37 (GG 4+3: 15 treated, 1 lost to f/u, 2 WW). Twenty-one men were lost to f/u, 36 discharged for PSA monitoring in the community and 5 died (1 prostate cancer-related). Time-to-AS exit was significantly different between patients with a lesion and those without. The difference persisted regardless of Gleason at diagnosis (log-rank test; p=0.0066 for 3+3, p=0.00069 for 3+4).
Men on AS with a Likert 4-5 at baseline have a distinct trajectory from those without a defined lesion, regardless of cancer grade at diagnosis. This could reflect a divergence in the history of visible and non-visible disease, increased monitoring vigilance of defined lesions, or both.
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