MRI-derived PRECISE score for predicting pathologically-confirmed progression in prostate cancer patients on active surveillance

Introduction The utilization of magnetic resonance imaging (MRI) in active surveillance (AS) of prostate cancer (PCa) remains a topic of debate. The Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system is used to evaluate the progression of MRI lesions in men undergoing AS. This study aims to evaluate the predictive capacity of the PRECISE score in monitoring PCa patients on AS. Material and methods A cohort of 63 men enrolled in an AS program between 2017 and 2021 was analyzed. Sequential MRIs within the AS protocol were assessed by a specialized radiologist using the PRECISE score. Data on biopsy outcomes, pathological progression, and treatment progression were documented. The relationship between progression and the PRECISE score was examined. Univariate logistic and Cox regression analyses were conducted to determine the baseline clinical and mpMRI parameters associated with disease progression. Results The cohort exhibited ISUP progression and biopsy progression rates of 27.6% (16/63) and 48.3% (28/63), respectively. At the second MRI, a PRECISE score exceeding 3 was observed in 31 patients (53.4%), with 25 patients (43.1%) showing new lesions. Overall, 23 patients (39.7%) underwent active treatment during a median follow-up of 117 months. The PRECISE score emerged as the sole predictor, in univariate analysis, of ISUP progression (OR: 3.2, IQR: 1.1–9.7, p = 0.04), biopsy progression (OR: 3.2, IQR: 1.1–9.7, p = 0.03), and active treatment (HR: 1.1, IQR: 1.0–1.6, p = 0.05). Conclusions The PRECISE scoring system facilitates the identification of patients at risk of ISUP and biopsy progression within an AS protocol utilizing mpMRI. These findings underscore the significance of mpMRI in AS.