Five-year Outcomes for Men after Negative Magnetic Resonance Imaging (MRI) or Negative Biopsy in the RAPID MRI-directed Prostate Cancer Diagnostic Pathway

Résumé fourni par la source

The magnetic resonance imaging–directed RAPID pathway is safe up to 5 yr of follow-up, with no metastases or cancer deaths. Fewer than one in 13 men developed grade group ≥2 prostate cancer, and only one in 20 needed treatment. Overall, 40% of men avoided biopsy. There is uncertainty over medium-term cancer outcomes for men who avoid biopsy (Bx) after nonsuspicious magnetic resonance imaging (MRI), and men with a negative Bx after suspicious MRI findings. We report on cancer diagnosis, treatment, and Bx rates for this population over a period of 5 yr. This single-centre cohort study followed men discharged from the RAPID prostate cancer diagnostic pathway between 2017 and 2023 with either negative MRI or negative prostate Bx, with at least 3 mo of follow-up. Patients with a Prostate Imaging-Reporting and Data System (PI-RADS) or Likert score of 1–2 on MRI or a score of 3 and prostate-specific antigen (PSA) density (PSAD) of <0.12 ng/ml 2 underwent PSA monitoring, while those with a score of 3 and PSAD >0.12 ng/ml 2 or a score of 4–5 were offered prostate Bx. Primary outcomes were grade group (GG) ≥2 diagnosis–free survival (Dx-FS) and treatment-free survival (TFS). Secondary outcomes were GG ≥3 Dx-FS, GG 1 Dx-FS, Bx-free survival (Bx-FS), cancer-specific survival, metastasis, and re-referral. Data were collected using a prospective data registry and electronic clinical records; patients with no recent follow-up (>1 yr) were directly contacted. Kaplan-Meier plots and multivariable Cox regression were used for statistical analysis. Of 2334 men investigated within the RAPID pathway, 1266 (927 no Bx, 339 negative Bx) were evaluated. Median follow-up was 3.4 yr (interquartile range 2.4–4.9). Seventy-four had GG ≥2 cancer and seven had GG 1 cancer. The 5-yr Dx-FS rates were 91.9% (95% confidence interval [CI] 90.0–93.9%) GG ≥2, 96.3% (95% CI 95.0–97.7%) for GG ≥3, and 99.4% (95% CI 98.9–99.8%) for GG 1. The 5-yr TFS rate was 94.4% (95% CI 92.6–95.9%). The 5-yr Bx-FS rate in the no-Bx group was 79.6% (95% CI 73.7–85.8%), leaving 39% (899/2334) of the original cohort Bx-free. No metastases or cancer-related deaths occurred. Higher PSAD and PI-RADS score and negative Bx, including atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasm findings, did not predict GG ≥2 diagnosis and treatment. Limitations include data excluded because of short follow-up (19%) and the single-centre evaluation. The RAPID MRI-directed pathway is safe in triaging men for Bx. At 5 yr, only one in 13 patients discharged from the RAPID pathway had GG ≥2 cancer and one in 20 required cancer treatment, while four in ten avoided Bx.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.