A new international study suggests the PRECISE score, an MRI-based reporting system, may help clinicians better identify radiological changes linked to biopsy progression in men on active surveillance for prostate cancer.
The retrospective multicenter study included 1,667 patients with low-risk or favorable intermediate-risk disease. Active surveillance is a standard approach to monitor cancer closely and avoid unnecessary treatment, preserving the option for curative intervention if the disease worsens.
Researchers evaluated the PRECISE scoring system, which ranges from 1 to 5: scores of 1-2 indicate regression, 3 indicates stability, and 4-5 suggest radiological progression.
MRI Changes Correlated with Biopsy Progression
Data was collected from 22 centers worldwide between December 2005 and July 2022. Eligible patients had at least two MRI scans and two biopsies. The median follow-up was four years; about half of patients underwent three or more MRIs during surveillance.
62% of patients had stable MRI findings (PRECISE 3), while 27% showed progression (PRECISE 4-5), and 11% showed regression. Of 1,248 patients with a biopsy immediately after their first follow-up MRI, 24% progressed to Grade Group 2 or higher.
Patients with PRECISE 4-5 scores had nearly 4.5 times higher odds of biopsy progression compared to those with PRECISE 1-3 scores.
Reducing Repeat Biopsies
Using a PRECISE threshold of 4 or higher to prompt biopsy showed 57% sensitivity, 79% specificity, and an 85% negative predictive value. This suggests that stable MRI findings, combined with PSA kinetics, could help select patients who can safely avoid repeat biopsy, while radiological progression may warrant earlier re-biopsy or treatment.
The study, published in European Radiology, is retrospective, and MRI changes alone would still miss some progression cases.