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Sequential MR for Prostate Cancer

How to do it.

PRECISE 1

Has been a group using RAND system to develop consensus about how to do F/U's:

Key recommendations include reporting the index lesion size using absolute values at baseline and at each subsequent MRI. Radiologists should assess the likelihood of true change over time (ie, change in size or change in lesion characteristics on one or more sequences) on a 1-5 scale. A checklist of items for reporting a cohort of men on active surveillance was developed. These items were developed based on expert consensus in many areas in which data are lacking, and they are expected to develop and change as evidence is accrued.

However I cannot download the actual paper just the abstract.

And is summarised in this table: 2

PRECISE SCORE Assesment of Likelihood of radiological progression
1 Resolution of previous features suspicious on MRI
2 Reduction in volume and/or conspicuity of features suspicious for prostate cancer
3 Stable MRI appearance: no new focal/diffuse lesions
4 Increase in size and/or conspicuity of features suspicious for prostate cancer
5 Definite radiologic stage progression (ECE, SV involvement, LN involvement, metastasis)

There is some reference to rebiopsy all >= 4.

Make several points:

  • No agreement which is best way to measure a lesion out of any.
  • 'Radiological progression' is a new and poorly defined construct as

there are yet no volume or diameter thresholds that allow us to reliably distinguish between expected interscan variability (which can be considerable [21]) and true progression

Footnotes

  1. Moore CM, Giganti F, Albertsen P, et al. 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. Eur Urol. 2017;71(4):648-655. doi:10.1016/j.eururo.2016.06.011 ↩

  2. Giganti, F., Pecoraro, M., Stavrinides, V. et al. Interobserver reproducibility of the PRECISE scoring system for prostate MRI on active surveillance: results from a two-centre pilot study. Eur Radiol 30, 2082–2090 (2020). https://doi.org/10.1007/s00330-019-06557-2 ↩