Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study

Nikita Sushentsev¹, Irene G Li², George Xu², Anne Y Warren³, Celeste Y Hsu², Madison Baxter², Dev Panchal², Christof Kastner⁴, Sean Fernando⁵, Ekaterina Pazukhina⁶, Oleg Blyuss⁷, Alexey Zaikin⁸, Ahmed Shabaik⁹, Anders M Dale¹⁰, Michael Liss¹¹, Tristan Barrett¹, Tyler M Seibert¹²

Affiliations

¹ Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
² Department of Radiation Medicine, University of California-San Diego, San Diego, CA, USA.
³ Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁴ Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵ School of Clinical Medicine, University of Cambridge, Cambridge, UK.
⁶ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.
⁸ Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Mathematics, University College London, London, UK; Institute for Cognitive Neuroscience, University Higher School of Economics, Moscow, Russia.
⁹ Department of Pathology, University of California-San Diego, La Jolla, CA, USA.
¹⁰ Department of Radiology, University of California-San Diego, La Jolla, CA, USA.
¹¹ Department of Urology, University of California-San Diego, La Jolla, CA, USA.
¹² Department of Radiation Medicine, University of California-San Diego, San Diego, CA, USA; Department of Radiology, University of California-San Diego, La Jolla, CA, USA; Department of Urology, University of California-San Diego, La Jolla, CA, USA; Department of Bioengineering, Jacobs School of Engineering, University of California-San Diego La Jolla, CA, USA. Electronic address: tseibert@health.ucsd.edu.

PMID: 40645823
DOI: 10.1016/j.euo.2025.06.012

Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study

Nikita Sushentsev et al. Eur Urol Oncol. 2025.

. 2025 Jul 10:S2588-9311(25)00190-7.

doi: 10.1016/j.euo.2025.06.012. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
² Department of Radiation Medicine, University of California-San Diego, San Diego, CA, USA.
³ Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁴ Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵ School of Clinical Medicine, University of Cambridge, Cambridge, UK.
⁶ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia.
⁸ Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Mathematics, University College London, London, UK; Institute for Cognitive Neuroscience, University Higher School of Economics, Moscow, Russia.
⁹ Department of Pathology, University of California-San Diego, La Jolla, CA, USA.
¹⁰ Department of Radiology, University of California-San Diego, La Jolla, CA, USA.
¹¹ Department of Urology, University of California-San Diego, La Jolla, CA, USA.
¹² Department of Radiation Medicine, University of California-San Diego, San Diego, CA, USA; Department of Radiology, University of California-San Diego, La Jolla, CA, USA; Department of Urology, University of California-San Diego, La Jolla, CA, USA; Department of Bioengineering, Jacobs School of Engineering, University of California-San Diego La Jolla, CA, USA. Electronic address: tseibert@health.ucsd.edu.

PMID: 40645823
DOI: 10.1016/j.euo.2025.06.012

Abstract

Background and objective: Magnetic resonance imaging (MRI)-driven active surveillance (AS) is increasingly used for management of prostate cancer (PC). The aim of our study was to determine the oncological safety of contemporary MRI-driven AS and identify patients at higher risk of AS failure.

Methods: This retrospective cohort study included AS patients with MRI-localised PC from three US and UK centres. The primary outcome was AS failure, which was defined as a composite of PC-specific mortality, metastasis, progression to grade group (GG) ≥4, or post-treatment biochemical recurrence. The secondary outcome was disease progression, defined as histological progression to GG 3 or progression to locally advanced disease. Hazard ratios (HRs) were estimated using multivariable Cox models, and multiplicity-adjusted log-rank tests were applied to compare event-free survival across subgroups.

Key findings and limitations: The study cohort comprised 719 patients with median follow-up of 5.2 yr. Of these patients, 629 (87%) had stable disease; 36 (5%) experienced AS failure, including eight (1%) cases of metastasis and no PC-related deaths; and 54 (8%) had disease progression. Cribriform GG 2 histology was the strongest predictor of AS failure (HR 12.7, 95% confidence interval [CI] 4.8-33.6; p < 0.001), followed by tumour MRI visibility (HR 5.0, 95% CI 1.5-16.5; p = 0.009) and noncribriform GG 2 histology (HR 3.4, 95% CI 1.6-7.0; p = 0.001). Event-free survival was comparable for MRI-invisible noncribriform GG 2 and all GG 1 tumours (adjusted p > 0.05 for both outcomes). The study is limited by its retrospective design.

Conclusions and clinical implications: Contemporary MRI-based AS for PC is safe for suitable patients, including men with noncribriform GG 2 tumours, particularly those that are MRI-invisible. Conversely, patients with cribriform GG 2 disease are at higher risk of AS failure, so consideration of upfront treatment is warranted for this subgroup.

Keywords: Active surveillance; Cribriform carcinoma; Magnetic resonance imaging; Prostate cancer.

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Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study

Affiliations

Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study

Authors

Affiliations

Abstract

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