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ESOU18: MRI in Men on Active Surveillance for Prostate Cancer: The PRECISE Recommendations

Amsterdam, The Netherlands (UroToday.com) Dr. Caroline Moore gave a summary talk on the PRECISE MRI guidelines.  There is growing interest in, and use of, MRI in men on active surveillance for low to intermediate risk prostate cancer (PC). A systematic review in 2014 [1] showed that there was no consistency in reporting the MRI data, either for an individual patient, or across cohorts, for men on active surveillance (AS). Whilst there were a number of consensus meetings setting out acquisition and reporting standards for MRI in the diagnostic setting, there were none specially addressing the questions that are most pertinent to men on AS:

 • What is a radiologically significant lesion for men on AS? 
 • How is significant change defined on MRI? 

The European School of Oncology convened a task force to make recommendations on MRI reporting for individual men and across cohorts of men on AS, to collect data in a robust manner across different centers. 

Experts in urology, radiology, and radiation oncology developed a set of 394 items, which were then scored for agreement by each panel member prior to the meeting. Each item was scored on a 1-9 scale, where 1 indicates a panel members complete disagreement, and 9 complete agreement with that item. Measures of agreement and consensus were calculated for each response. The most important statements, derived from group discussion, and measures of agreement and consensus, were used to create the PC Radiological Estimation of Change in Sequential Evaluation (PRECISE) checklist and case report form. 

The PRECISE checklist consists of recommendations for both the conduction and reporting of an individual MRI scan, and for reporting cohorts of men who have had MRI at baseline or during follow up on AS. A Likert scale for the reporting of the likelihood of radiological progression was established. 

The use of MRI in AS in PC has the potential to identify men with higher risk disease suitable for active treatment at baseline; to more accurately detect true change when it occurs and to safely reassure men at lowest risk. This will result in reduction of unnecessary biopsies in these men. To realize the full potential of MRI in AS, there needs to be a robust cohort analysis in order to inform the appropriate thresholds for radiological lesions suitable for AS vs active treatment, and to determine the clinical significance of radiological change over time. The PRECISE guidelines and proforma can be used to report individual MRI scans in men on AS at baseline or follow up, and to analyze data across cohorts of men.


Speaker: Caroline Moore, MD, Consultant Urological Surgeon London Urology Associates, United Kingdom

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands

References:

1. Schoots IG, Petrides N, Giganti F, Bokhorst LP, Rannikko A, Klotz L, Villers A, Hugosson J, Moore CM. Magnetic resonance imaging in active surveillance of prostate cancer: a systematic review. Eur Urol. 2015 Apr;67(4):627-36. doi: 10.1016/j.eururo.2014.10.050. Epub 2014 Nov 15.

Read More:
Reporting Magnetic Resonance Imaging in Men on Active Surveillance for Prostate Cancer: The PRECISE Recommendations-A Report of a European School of Oncology Task Force.