BACKGROUND Active surveillance (AS) protocols rely on rectal examination, prostate-specific antigen, imaging, and biopsy to identify disease progression. OBJECTIVE To evaluate whether an AS regimen based on magnetic resonance imaging (MRI) or clinical stage changes can detect reclassification to grade group (GG) ≥2 disease compared with scheduled systematic biopsies. DESIGN, SETTING, AND PARTICIPANTS We identified a cohort of men initiated on AS between January 2013 and April 2016 at a single tertiary-care center. Patients completed confirmatory testing and prostate MRI prior to enrollment, then underwent laboratory and physical evaluation every 6 mo, MRI every 18 mo, and biopsy every 3yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS MRI results were evaluated using composite Likert/Prostate Imaging Reporting and Data System v2 scoring. MRI and clinical changes were assessed for association with disease progression. Univariable and multivariable regression models were used to predict upgrading on 3-yr biopsy. RESULTS AND LIMITATIONS At 3yr, of 207 men, 66 (32%) had≥GG2 at biopsy: 55 (83%) with GG2, 10 (15%) with GG3, and one (1.5%) with GG4. Among patients with a 3-yr MRI score of ≥3, 41% had≥GG2 disease, compared with 15% with an MRI score of <3 (p=0.0002). The MRI score increased in 48 men (23%), decreased in 27 (13%), and was unchanged in 132 (64%) men. Increases in MRI score were not associated with reclassification after adjusting for the 3-yr MRI score (p=0.9). Biopsying only for an increased MRI score or clinical stage would avoid 681 biopsies per 1000 men, at the cost of missing ≥GG2 disease in 169 patients. CONCLUSIONS An AS strategy that uses MRI or clinical changes to trigger prostate biopsy avoids many biopsies but misses an unacceptable amount of clinically significant disease. Prostate biopsy for men on AS should be performed at scheduled intervals, regardless of stable imaging or examination findings. PATIENT SUMMARY An active surveillance strategy for biopsy based only on increases in magnetic resonance imaging score or clinical stage will avoid many biopsies; however, it will miss many patients with clinically significant prostate cancer.

中文翻译：

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磁共振成像或临床分期的变化在积极监测前列腺癌男性疾病进展中的作用。

背景技术主动监视（AS）协议依赖于直肠检查，前列腺特异性抗原，成像和活检来识别疾病进展。目的评估与计划的系统活检相比，基于磁共振成像（MRI）或临床分期改变的AS方案是否可以检测到重分类为（GG）≥2级疾病。设计，地点和参与者我们确定了2013年1月至2016年4月间在AS上由一个三级护理中心发起的一组男性。患者在入组前先完成验证性测试和前列腺MRI，然后每6个月进行实验室和物理评估，每18个月进行MRI，每3年进行活检。结果测量和统计分析MRI结果使用李克特/前列腺成像综合报告和数据系统v2评分进行评估。评估MRI和临床变化与疾病进展的关系。单变量和多变量回归模型用于预测3年期活检的升级。结果与局限性在3年的207名男性中，有66名（32％）活检≥GG2：GG2为55（83％），GG3为10（15％），而GG4为1（1.5％）。在3年MRI评分≥3的患者中，≥GG2疾病占41％，而MRI评分<3则为15％（p = 0.0002）。MRI评分增加了48位男性（23％），降低了27位（13％），而132位（64％）男性没有变化。调整3年MRI评分后，MRI评分增加与重新分类无关（p = 0.9）。仅针对增加的MRI评分或临床分期进行活检将避免每1000名男性进行681例活检，这会导致169例患者丢失≥GG2疾病。结论采用MRI或临床改变触发前列腺穿刺活检的AS策略避免了许多活检，但却错过了不可接受的大量临床重要疾病。无论稳定的影像学检查或检查结果如何，应按计划的时间间隔对AS的男性进行前列腺活检。患者总结仅基于磁共振成像评分或临床分期增加的活检的主动监视策略将避免进行许多活检。但是，它将错过许多具有临床意义的前列腺癌患者。患者总结仅基于磁共振成像评分或临床分期增加的活检的主动监视策略将避免进行许多活检。但是，它将错过许多具有临床意义的前列腺癌患者。病人总结仅基于磁共振成像评分或临床分期增加的活检的主动监视策略将避免进行许多活检。但是，它将错过许多具有临床意义的前列腺癌患者。