Session: MP38: Prostate Cancer: Localized: Active Surveillance
MP38-18: Incorporating the PRECISE Recommendations to Evaluate Progression in Men on Active Surveillance for Low-grade Prostate Cancer: Which Patients with Low PRECISE Score Need a Confirmatory Biopsy?
Introduction: The PRECISE score evaluates MRI characteristics for prostate cancer (PCa) patients with serial scans during active surveillance (AS). Although patients with reassuring characteristics at follow-up MRI (PRECISE 1-3) might have low risk of reclassification, a subgroup of these men should receive a re-biopsy. Methods: We identified 207 PCa patients on AS (2016-2022) with at least two consecutive MRIs assessed with the PRECISE recommendations. Follow-up biopsies were performed at clinical or radiological progression. One radiologist reviewed the images and retrospectively assigned the PRECISE score. Reclassification was defined as an increase in biopsy grade group from baseline biopsy. Kaplan-Meier analyses assessed reclassification-free survival (RFS). Cox regression tested the prognostic impact of the first PRECISE score. Multivariable Cox regression tested predictors of reclassification among men with reassuring characteristics (PRECISE 1-3). Results: Overall, 144 men had visible lesions (PI-RADS 3-5) at baseline scan. At a median follow-up of 43 months, 21 patients had MRI regression (PRECISE 1-2), 54 were stable without lesions (PRECISE 3), 98 were stable with lesions (PRECISE 3), and 34 had progression (PRECISE 4-5). The 5-year RFS for PRECISE 1-2, non-visible 3, visible 3, and 4-5 was 85%, 73%, 57%, and 52% (Fig. 1a). A PRECISE score of 4-5 was an independent predictor of reclassification (HR 4.62, p=0.01). At two years from the second MRI, RFS was 91% for PI-RADS 1-3 and PSAD <0.15 ng/cc/cc, and 55% for either PI-RADS 4-5 or PSAD =0.15 ng/cc/cc (p < 0.001, Fig. 1b). At multivariable analyses suspicious findings at the second scan (PI-RADS 4-5, HR 3.47, p=0.001), and PSAD =0.15 ng/cc/cc (HR 2.17, p=0.03) were independently associated with reclassification among men with PRECISE 1-3 score. Conclusions: Up to 50% of men with PRECISE 1-3 MRIs and PSAD =0.15 ng/cc/cc or PI-RADS 4-5 lesions at first MRI experience reclassification at 2-year. Despite stable MRI, these patients should undergo a re-biopsy. In patients with signs of progression, or persistence of visible lesions, a more stringent follow-up is warranted. SOURCE OF Funding: None
