20 research outputs found
A Multivariable Approach Using Magnetic Resonance Imaging to Avoid a Protocol-based Prostate Biopsy in Men on Active Surveillance for Prostate Cancer-Data from the International Multicenter Prospective PRIAS Study
Publisher Copyright: Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.BACKGROUND: There is ongoing discussion whether a multivariable approach including magnetic resonance imaging (MRI) can safely prevent unnecessary protocol-advised repeat biopsy during active surveillance (AS). OBJECTIVE: To determine predictors for grade group (GG) reclassification in patients undergoing an MRI-informed prostate biopsy (MRI-Bx) during AS and to evaluate whether a confirmatory biopsy can be omitted in patients diagnosed with upfront MRI. DESIGN, SETTING, AND PARTICIPANTS: The Prostate cancer Research International: Active Surveillance (PRIAS) study is a multicenter prospective study of patients on AS (www.prias-project.org). We selected all patients undergoing MRI-Bx (targeted ± systematic biopsy) during AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A time-dependent Cox regression analysis was used to determine the predictors of GG progression/reclassification in patients undergoing MRI-Bx. A sensitivity analysis and a multivariable logistic regression analysis were also performed. RESULTS AND LIMITATIONS: A total of 1185 patients underwent 1488 MRI-Bx sessions. The time-dependent Cox regression analysis showed that age (per 10 yr, hazard ratio [HR] 0.84 [95% confidence interval {CI} 0.71-0.99]), MRI outcome (Prostate Imaging Reporting and Data System [PIRADS] 3 vs negative HR 2.46 [95% CI 1.56-3.88], PIRADS 4 vs negative HR 3.39 [95% CI 2.28-5.05], and PIRADS 5 vs negative HR 4.95 [95% CI 3.25-7.56]), prostate-specific antigen (PSA) density (per 0.1 ng/ml cm3, HR 1.20 [95% CI 1.12-1.30]), and percentage positive cores on the last systematic biopsy (per 10%, HR 1.16 [95% CI 1.10-1.23]) were significant predictors of GG reclassification. Of the patients with negative MRI and a PSA density of <0.15 ng/ml cm3 (n = 315), 3% were reclassified to GG ≥2 and 0.6% to GG ≥3. At the confirmatory biopsy, reclassification to GG ≥2 and ≥3 was observed in 23% and 7% of the patients diagnosed without upfront MRI and in 19% and 6% of the patients diagnosed with upfront MRI, respectively. The multivariable analysis showed no significant difference in upgrading at the confirmatory biopsy between patients diagnosed with or without upfront MRI. CONCLUSIONS: Age, MRI outcome, PSA density, and percentage positive cores are significant predictors of reclassification at an MRI-informed biopsy. Patients with negative MRI and a PSA density of <0.15 ng/ml cm3 can safely omit a protocol-based prostate biopsy, whereas in other patients, a multivariable approach is advised. Being diagnosed with upfront MRI appears not to significantly affect reclassification risk; hence, a confirmatory MRI-Bx cannot totally be omitted yet. PATIENT SUMMARY: A protocol-based prostate biopsy while on active surveillance can be omitted in patients with negative magnetic resonance imaging (MRI) and prostate-specific antigen density <0.15 ng/ml cm3. A confirmatory biopsy cannot simply be omitted in all patients diagnosed with upfront MRI.Peer reviewe
PSA non négative après prostatectomie totale : facteurs pronostiques de progression et de succés d'une radiothérapie de rattrapage. Etude multicentrique
REIMS-BU Santé (514542104) / SudocSudocFranceF
Résultats des ultrasons focalisés de haute intensité dans le traitement du cancer de prostate cliniquement localisé : l'experience d'un centre après 6 ans d'utilisation
REIMS-BU Santé (514542104) / SudocSudocFranceF
Prothèses péniennes : étude multicentrique, intérêt des centres experts
REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Sexualité après traitement curatif du cancer localisé de la prostate par prostatectomie totale ou curiethérapie : développement d'un auto-questionnaire et évaluation clinique
REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
La ploïdie cellulaire : facteur prédictif de marges chirurgicales positives dans le cancer de prostate cliniquement localisé
REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Expression immunohistochimique et valeur pronostique sur la récidive biologique de l'endothéline 1 et de son récepteur A dans l'adébocarcinome prostatique cliniquement localisé
REIMS-BU Santé (514542104) / SudocSudocFranceF
Expression immunohistochimique de l'Endothéline-1 sur biopsie (intérêt pour le pronostic d'effraction capsulaire dans l'adenocarcinome prostatique)
REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Adénocarcinome prostatique localement avancé : expression immunohistochimique de l'endothéline-1 et du récepteur A ; valeur prédictive pour l'envahissement ganglionnaire, valeur pronostique pour la reprise évolutive biologique
REIMS-BU Santé (514542104) / SudocSudocFranceF