Clinical Application of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation Score for Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer

• Published in: European urology open science (Online) 2023-10, Vol.56, p.39-46
• Main Authors: Aerts, Jan, Hendrickx, Sigi, Berquin, Camille, Lumen, Nicolaas, Verbeke, Sofie, Villeirs, Geert, Van Praet, Charles, De Visschere, Pieter
• Format: Article
• Language: English
• Subjects: Active surveillance; Follow-up; Imaging; Magnetic resonance imaging; Prostate Cancer; Prostate Cancer Radiological Estimation of Change in Sequential Evaluation
• ISSN: 2666-1683; 2666-1691; 2666-1683
• DOI: 10.1016/j.euros.2023.08.006

Standardised reporting of repeat magnetic resonance imaging scans in active surveillance of prostate cancer, using the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation recommendations, is feasible and offers a prognostic value. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) score has been developed to standardise prostate magnetic resonance imaging (MRI) reporting in men on active surveillance (AS) for prostate cancer (PCa). To evaluate the feasibility of PRECISE scoring and assess its diagnostic accuracy. All PCa patients on AS with a baseline MRI and at least one follow-up MRI scan between January 2008 and September 2022 at a single tertiary referral centre were included in a database. The follow-up protocol of the Prostate Cancer International Active Surveillance (PRIAS) study was used. All scans were retrospectively re-reported by a dedicated uroradiologist and appointed a Prostate Imaging Reporting and Data System (version 2.1) and PRECISE score. Clinically significant progression was defined by histopathological upgrading (on biopsy or radical prostatectomy) to grade group ≥3 and/or evolution to T3 stage. A survival analysis was performed to assess differential progression-free survival (PFS) according to the PRECISE score. A total of 188 patients were included for an analysis with a total of 358 repeat MRI scans and 144 repeat biopsies. The median follow-up was 46 mo (interquartile range 21–74). Radiological progression (PRECISE 4–5) had sensitivity, specificity, negative predictive value, and positive predictive value of, respectively, 78%, 70%, 90%, and 49% for clinically significant progression. Four-year PFS was 91% for PRECISE 1–3 versus 66% for PRECISE 4–5 (p