Prostate Cancer Active Surveillance Criteria May Need Updating

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When MRI-US fusion biopsy is added to the standard 12-core biopsy, the number of men eligible for active surveillance decreases, study finds.
When MRI-US fusion biopsy is added to the standard 12-core biopsy, the number of men eligible for active surveillance decreases, study finds.

Adding magnetic resonance imaging-ultrasound (MRI-US) fusion prostate biopsy to the standard 12-core prostate biopsy significantly increases the number of prostate cancer (PCa) patients who would be deemed ineligible for active surveillance using currently available selection criteria, according to study findings reported at the Society of Urologic Oncology 17th annual meeting in San Antonio, Texas.

As a result, active surveillance (AS) criteria need to be updated to reflect the increased use of MRI-US fusion prostate biopsy, investigators led by Bruno Nahar, MD, and Sanoj Punnen, MD, at the University of Miami Miller School of Medicine, concluded in a poster presentation.

The investigators studied 100 PCa patients who were eligible for active surveillance (AS) based on a 12-core standard prostate biopsy and meeting at least 1 of 7 sets of AS criteria (Johns Hopkins University, the University of Toronto, the University of California-San Francisco (UCSF), the Prostate Cancer Research International Active Surveillance (PRIAS) project, the Royal Marsden Hospital, Memorial Sloan Kettering Cancer Center (MSKCC), and the University of Miami.

After adding MRI-US fusion biopsy cores, the proportion of men who became ineligible for AS varied depending on the criteria, ranging from 10.3% using the Royal Marsden criteria, which is a very inclusive criteria, to 40.7% using the University of Miami criteria, which uses more strict criteria to select patients for AS. The proportions were 17.0%, 21.1%, 26.3%, 33.3%, and 38.5% for the University of Toronto, UCSF, MSKCC, Johns Hopkins, and PRIAS criteria, respectively.

“Criteria that incorporated an absolute maximum number of cores positive (usually 2) had the highest rates of ineligibility after adding the fusion cores,” Drs Nahar and Punnen told Renal & Urology News in a joint statement by email. “Using the percent of positive cores instead of an absolute number allowed fewer exclusions by accounting for the extra cores being taken during targeted biopsy.”

Reference

1. Nahar B, Katims A, Prakash, NS, et al. Reclassification rates of patients on active surveillance after the addition of MRI-US fusion biopsy of the prostate: An analysis of the seven most used criteria on a prospective cohort of men. Presented at the Society of Urologic Oncology 17th annual meeting in San Antonio, Texas. Poster 104.

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