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Active surveillance inclusion criteria under scrutiny in magnetic resonance imaging-guided prostate biopsy: a multicenter cohort study

BACKGROUND: Although multiparametric magnetic resonance imaging (mpMRI) is recommended for primary risk stratification and follow-up in Active Surveillance (AS), it is not part of common AS inclusion criteria. The objective was to compare AS eligibility by systematic biopsy (SB) and combined MRI-targ...

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Main Authors: Kornienko, Kira (Author) , Siegel, Fabian (Author) , Borkowetz, Angelika Sabina Maria (Author) , Hoffmann, Manuela Andrea (Author) , Drerup, Martin (Author) , Lieb, Verena (Author) , Bründl, Johannes (Author) , Höfner, Thomas (Author) , Cash, Hannes (Author) , Hardenberg, Jost von (Author) , Westhoff, Niklas Christian (Author)
Format: Article (Journal)
Language:English
Published: 2022
In: Prostate cancer and prostatic diseases
Year: 2022, Volume: 25, Issue: 1, Pages: 109-116
ISSN:1476-5608
DOI:10.1038/s41391-021-00478-2
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1038/s41391-021-00478-2
Verlag, kostenfrei, Volltext: https://www.nature.com/articles/s41391-021-00478-2
Resolving-System, kostenfrei: http://dx.doi.org/10.1038/s41391-021-00478-2
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Author Notes:Kira Kornienko, Fabian Siegel, Angelika Borkowetz, Manuela A. Hoffmann, Martin Drerup, Verena Lieb, Johannes Bruendl, Thomas Höfner, Hannes Cash, Jost von Hardenberg, Niklas Westhoff, GESRU Academics Prostate Cancer Group, Jost von Hardenberg, Burkhard Beyer, Johannes Bründl, Johannes Cash, Jonas Herrmann, Jan Philipp Radtke, Manuela A. Hoffmann, Conrad Leitsmann, Kira Kornienko, Thomas Worst, Hendrik Borgmann, Johannes Linxweiler, Niklas Klümper, Mike Wenzel, Maria Noemi Welte, Niklas Westhoff, Christoph Würnschimmel, August Sigle, Samy Mahjoub, Gernot Ortner, Jeremy Kwe, Sven-Thorben Langenberger
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Summary:BACKGROUND: Although multiparametric magnetic resonance imaging (mpMRI) is recommended for primary risk stratification and follow-up in Active Surveillance (AS), it is not part of common AS inclusion criteria. The objective was to compare AS eligibility by systematic biopsy (SB) and combined MRI-targeted (MRI-TB) and SB within real-world data using current AS guidelines. - METHODS: A retrospective multicenter study was conducted by a German prostate cancer (PCa) working group representing six tertiary referral centers and one outpatient practice. Men with PCa and at least one MRI-visible lesion according to Prostate Imaging Reporting and Data System (PI-RADS) v2 were included. Twenty different AS inclusion criteria of international guidelines were applied to calculate AS eligibility using either a SB or a combined MRI-TB and SB. Reasons for AS exclusion were assessed. - RESULTS: Of 1941 patients with PCa, per guideline, 583-1112 patients with PCa in both MRI-TB and SB were available for analysis. Using SB, a median of 22.1% (range 6.4-72.4%) were eligible for AS. Using the combined approach, a median of 15% (range 1.7-68.3%) were eligible for AS. Addition of MRI-TB led to a 32.1% reduction of suitable patients. Besides Gleason Score upgrading, the maximum number of positive cores were the most frequent exclusion criterion. Variability in MRI and biopsy protocols potentially limit the results. - CONCLUSIONS: Only a moderate number of patients with PCa can be monitored by AS to defer active treatment using current guidelines for inclusion in a real-world setting. By an additional MRI-TB, this number is markedly reduced. These results underline the need for a contemporary adjustment of AS inclusion criteria. Prostate Cancer and Prostatic Diseases (2022) 25:109-116; https://doi.org/10.1038/s41391-021-00478-2
Item Description:Gesehen am 02.10.2023
Physical Description:Online Resource
ISSN:1476-5608
DOI:10.1038/s41391-021-00478-2

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