Cribriform Status at Follow-up Biopsy Is Critical for Predicting Prostate Cancer Active Surveillance Failure in the MRI Era: a Transatlantic Cohort Study
- 1University of California San Diego
Abstract
PurposeTo assess whether follow-up MRI, biopsy status, and timing of cribriform disease detection predict active surveillance (AS) failure in a contemporary transatlantic cohort.
Materials and Methods.Retrospective MRI-driven AS cohort of 619 men at two academic centers (UK/USA), 2012-2024. Primary outcome: AS failure (disease-specific mortality, metastasis, grade group [GG] [≥]4 progression, or post-treatment biochemical recurrence). Key exposures: final MRI and biopsy status, timing of cribriform [≥]GG2 detection. Cumulative incidence was derived; independent predictors used multivariable Fine-Gray models.
Results.Over median follow-up of 6.4 years, 39/619 men (6%) experienced AS failure. Cribriform [≥]GG2 was detected in 82/619 (13%) on follow-up biopsy versus 24/619 (4%) at baseline, comparably in baseline GG1 (10%) and non-cribriform GG2 (9%), and only in MRI-visible tumors. Three-year AS failure after final biopsy was 31% in men with cribriform [≥]GG2 versus 0-2% with stable or non-cribriform disease; 44% of failures had stable MRI. On Fine-Gray analysis, cribriform [≥]GG2 was the only independent predictor of AS failure in re-biopsied men (SHR 30; 95% CI 5.2-167; P<0.001); no type of MRI progression category was independently predictive. Among 595 men cribriform-negative at baseline, 6-year AS failure after a second biopsy was 34% if cribriform [≥]GG2 was detected versus 7% if still cribriform-negative.
Conclusions.Cribriform status at follow-up biopsy independently predicts AS failure, whereas MRI progression does not. The three-fold higher cribriform prevalence at follow-up likely reflects baseline sampling error. Because newly detected cribriform tumours were exclusively MRI-visible, early repeat biopsy of patients with MRI-visible disease may considerably improve risk stratification.
Related
- Baseline Patient and Tumour Characteristics Associated with Mental Health in Men Undergoing Active Surveillance for Prostate Cancer
- Transcriptome profiling of cell-free RNAs in prostate cancer patients on active surveillance
- FAP‐Associated Cribriform Morular Thyroid Carcinoma: A Warning Sign for Sigmoid Colon Cancer
- Exercise During Active Surveillance for Localized Low-Risk Prostate Cancer: Current Evidence and a Survivorship Framework.
- From Radical Treatment to Structured Active Surveillance: A Narrative Review of Low-Risk Localized Prostate Cancer
BibTeX
@misc{sushentsev2026cribriform,
title = {{Cribriform Status at Follow-up Biopsy Is Critical for Predicting Prostate Cancer Active Surveillance Failure in the MRI Era: a Transatlantic Cohort Study}},
author = {N. Sushentsev and G. Xu and I. G. Li and S. Do and J. Liu and M. Kim and C. Kastner and S. Fernando and A. M. Dale and A. Y. Warren and A. M. Dale and M. Liss and T. Barrett and T. M. Seibert},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.19.26365918},
url = {https://www.medrxiv.org/content/10.64898/2026.10.19.26365918v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Cribriform Status at Follow-up Biopsy Is Critical for Predicting Prostate Cancer Active Surveillance Failure in the MRI Era: a Transatlantic Cohort Study
AU - N. Sushentsev
AU - G. Xu
AU - I. G. Li
AU - S. Do
AU - J. Liu
AU - M. Kim
AU - C. Kastner
AU - S. Fernando
AU - A. M. Dale
AU - A. Y. Warren
AU - A. M. Dale
AU - M. Liss
AU - T. Barrett
AU - T. M. Seibert
PY - 2026
DA - 2026/10/19
PB - medRxiv
DO - 10.64898/2026.10.19.26365918
UR - https://www.medrxiv.org/content/10.64898/2026.10.19.26365918v1
AB - PurposeTo assess whether follow-up MRI, biopsy status, and timing of cribriform disease detection predict active surveillance (AS) failure in a contemporary transatlantic cohort. Materials and Methods.Retrospective MRI-driven AS cohort of 619 men at two academic centers (UK/USA), 2012-2024. Primary outcome: AS failure (disease-specific mortality, metastasis, grade group [GG] [≥]4 progression, or post-treatment biochemical recurrence). Key exposures: final MRI and biopsy status, timing of cribriform [≥]GG2 detection. Cumulative incidence was derived; independent predictors used multivariable Fine-Gray models. Results.Over median follow-up of 6.4 years, 39/619 men (6%) experienced AS failure. Cribriform [≥]GG2 was detected in 82/619 (13%) on follow-up biopsy versus 24/619 (4%) at baseline, comparably in baseline GG1 (10%) and non-cribriform GG2 (9%), and only in MRI-visible tumors. Three-year AS failure after final biopsy was 31% in men with cribriform [≥]GG2 versus 0-2% with stable or non-cribriform disease; 44% of failures had stable MRI. On Fine-Gray analysis, cribriform [≥]GG2 was the only independent predictor of AS failure in re-biopsied men (SHR 30; 95% CI 5.2-167; P<0.001); no type of MRI progression category was independently predictive. Among 595 men cribriform-negative at baseline, 6-year AS failure after a second biopsy was 34% if cribriform [≥]GG2 was detected versus 7% if still cribriform-negative. Conclusions.Cribriform status at follow-up biopsy independently predicts AS failure, whereas MRI progression does not. The three-fold higher cribriform prevalence at follow-up likely reflects baseline sampling error. Because newly detected cribriform tumours were exclusively MRI-visible, early repeat biopsy of patients with MRI-visible disease may considerably improve risk stratification.
ER -