Visible disease at baseline accelerates time to exit from MRI-based active surveillance.
BAUS ePoster online library. Stavrinides V. Jun 24, 2019; 259552; P5-8
Mr. Vasilis Stavrinides
Mr. Vasilis Stavrinides
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Abstract
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INTRODUCTION:
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.
METHODS:
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.
RESULTS:
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).
CONCLUSIONS:
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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