The added influence of genomics and post-MRI confirmatory biopsy results to MRI results alone on medical decision making for men with favorable risk prostate cancer being considered for active surveillance

Michael Wang; Ji Qi; Arvin K George; Alice Semerjian; Susan M Linsell; James E Montie; Michael L Cher; Kevin B Ginsburg; Michigan Urological Surgery Improvement Collaborative

doi:10.1002/pros.24357

The added influence of genomics and post-MRI confirmatory biopsy results to MRI results alone on medical decision making for men with favorable risk prostate cancer being considered for active surveillance

Prostate. 2022 Jun;82(10):1068-1074. doi: 10.1002/pros.24357. Epub 2022 Apr 25.

Authors

Michael Wang¹, Ji Qi², Arvin K George², Alice Semerjian³, Susan M Linsell², James E Montie², Michael L Cher¹, Kevin B Ginsburg^{1

4}; Michigan Urological Surgery Improvement Collaborative

Affiliations

¹ Department of Urology, Wayne State University, Detroit, Michigan, USA.
² University of Michigan Medical School, Ann Arbor, Michigan, USA.
³ IHA Urology, St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA.
⁴ Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.

PMID: 35468226
DOI: 10.1002/pros.24357

Abstract

Background: We examined how the results of genomic classifier (GC) or post-magnetic resonance imaging confirmatory biopsy (pMRI-CBx) influenced management strategy for men with an MRI considering active surveillance (AS).

Methods: We reviewed the Michigan Urological Surgery Improvement Collaborative registry for men with favorable-risk prostate cancer. Among men with an MRI after the diagnostic biopsy (n = 1162) a subset also had GC (n = 126) or pMRI-CBx (n = 309). Results of MRI, GC, and pMRI-CBx were deemed reassuring (RA) or non-reassuring (Non-RA). We assess the association of the combination of test results obtained with the selection of AS. Proportions were compared with the Fisher's exact test. Multivariable logistic regression models were fit for an association of test results with the selection of AS.

Results: The results of pMRI-CBx tended to influence management decisions greater than that of GC, especially in situation where testing results were discordant with the MRI result. Fewer men with a RA MRI and non-RA pMRI-CBx where managed with AS compared with RA MRI alone (31% vs. 86%, p < 0.001). non-RA genomics did not seem to have the same influence on management as non-RA pMRI-CBx as a similar proportion of men with RA MRI and non-RA genomics were managed with AS compared with RA MRI alone (85% vs. 86%, p = 0.753). More men with non-RA MRI and RA pMRI-CBx were managed with AS compared with non-RA MRI alone (89% vs. 40%, p < 0.001). Alternatively, a similar proportion of men with non-RA MRI and RA genomics were managed with AS compared with non-RA MRI alone (42% vs. 40%, p > 0.999). In the multivariable models, pMRI-CBx results influenced the decision for AS versus treatment.

Conclusions: In men with newly diagnosed prostate cancer and an MRI, the additional information provided by pMRI-CBx influenced the decision of AS versus treatment, while the addition of GC results were less influential.

Keywords: active surveillance; genomics; magnetic resonance imaging; prostate cancer.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Biopsy
Clinical Decision-Making
Genomics
Humans
Image-Guided Biopsy / methods
Magnetic Resonance Imaging / methods
Male
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / genetics
Watchful Waiting*