Results of radical prostatectomy and short-term follow-up of men with ISUP GG 1 and 2 prostate cancer who underwent magnetic resonance imaging-guided active surveillance.
12 affiliations
- 1Department of Urology, Medical Faculty, University of Düsseldorf, Germany.
- 2Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- 3Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Germany.
- 4Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- 5Department of Urology and Paediatric Urology, Elisabeth-Krankenhaus Rheydt, Staedtische Kliniken Moenchengladbach GmbH, Germany.
- 6Department of Urology, University Hospital Essen, Germany.
- 7Department of Radiology, University College London Hospitals NHS Foundation Trust, United Kingdom.
- 8Division of Surgery and Interventional Science, University College London, United Kingdom.
- 9Department of Urology, Kliniken Maria Hilf GmbH, Moenchengladbach, Germany.
- 10Institute of Pathology, Medical Faculty, University of Düsseldorf, Germany.
- 11Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Germany.
- 12Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Abstract
Introduction
Multiparametric magnetic resonance imaging (mpMRI) reduces the need for repeat biopsies in prostate cancer (PC) patients under active surveillance (AS). The prospective PROMM-AS trial confirmed reliable prediction of upgrading in ISUP Grade Group (GG) 1-2 PC. We report outcomes of men from the PROMM-AS trial undergoing deferred radical prostatectomy (RP) after radiologic or histopathologic progression, including short-term oncological follow-up.Material and methods
The primary endpoint was biochemical recurrence (BCR; PSA ≥0.1 ng/ml). Secondary endpoints included adverse pathology (AP; ISUP GG ≥3 and/or ≥pT3 at RP), PSA level at 12 months, and metastases. Differences between ISUP GG were evaluated using Fisher's exact test. Sensitivity, specificity, positive and negative predictive value to predict BCR and AP were calculated. Regression analyses using MRI and clinical variables were performed to analyze predictors of BCR and AP.Results
Of 148 men, 28 (19%) - 10 GG1 and 18 GG2 - progressed (radiologic n=15, histopathologic n = 3, combined n = 10) and underwent RP within 24 months of trial duration. Median follow-up after RP was 24 months (IQR 15-38). Among 25 patients with ≥12 months follow-up, 92% achieved PSA <0.01 ng/ml at 12 months. BCR occurred in 4 patients (14%), AP in 9 (32%), and 1 patient (3.6%) developed pelvic lymph node metastasis. Gleason Pattern (GP) 4 at biopsy, PI-RADS, and PRECISE scores significantly predicted BCR, while GP4 percentage, percentage of positive cores and PI-RADS predicted AP.Conclusions
These findings support the oncological safety of MRI-guided AS in terms of BCR and development of metastases in selected GG1/2 PC patients. However, the rate of AP needs to be acknowledged in patient counseling.
Related
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- Surgical Team Composition and Outcomes After Radical Prostatectomy for Prostate Cancer.
- Institutional Variation in MRI Utilization After Prostatectomy for Prostate Cancer: A Multicenter Study.
BibTeX
@article{busshoff2026results,
title = {{Results of radical prostatectomy and short-term follow-up of men with ISUP GG 1 and 2 prostate cancer who underwent magnetic resonance imaging-guided active surveillance.}},
author = {Isabelle Busshoff and Rouvier Al-Monajjed and Lars Schimmöller and Christian Arsov and Birte Valentin and Jale Lakes and Tim Ullrich and Boris A Hadaschik and Francesco Giganti and Markus Giessing and Tilman T Rau and Irene Esposito and Gerald Antoch and Peter Albers and Matthias Boschheidgen and Jan Philipp Radtke},
journal = {Central European journal of urology},
year = {2026},
month = jul,
doi = {10.5173/ceju.2025.0285},
url = {https://europepmc.org/article/MED/42903620},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Results of radical prostatectomy and short-term follow-up of men with ISUP GG 1 and 2 prostate cancer who underwent magnetic resonance imaging-guided active surveillance.
AU - Isabelle Busshoff
AU - Rouvier Al-Monajjed
AU - Lars Schimmöller
AU - Christian Arsov
AU - Birte Valentin
AU - Jale Lakes
AU - Tim Ullrich
AU - Boris A Hadaschik
AU - Francesco Giganti
AU - Markus Giessing
AU - Tilman T Rau
AU - Irene Esposito
AU - Gerald Antoch
AU - Peter Albers
AU - Matthias Boschheidgen
AU - Jan Philipp Radtke
PY - 2026
DA - 2026/07/07
JO - Central European journal of urology
DO - 10.5173/ceju.2025.0285
UR - https://europepmc.org/article/MED/42903620
AB - Introduction Multiparametric magnetic resonance imaging (mpMRI) reduces the need for repeat biopsies in prostate cancer (PC) patients under active surveillance (AS). The prospective PROMM-AS trial confirmed reliable prediction of upgrading in ISUP Grade Group (GG) 1-2 PC. We report outcomes of men from the PROMM-AS trial undergoing deferred radical prostatectomy (RP) after radiologic or histopathologic progression, including short-term oncological follow-up.Material and methods The primary endpoint was biochemical recurrence (BCR; PSA ≥0.1 ng/ml). Secondary endpoints included adverse pathology (AP; ISUP GG ≥3 and/or ≥pT3 at RP), PSA level at 12 months, and metastases. Differences between ISUP GG were evaluated using Fisher's exact test. Sensitivity, specificity, positive and negative predictive value to predict BCR and AP were calculated. Regression analyses using MRI and clinical variables were performed to analyze predictors of BCR and AP.Results Of 148 men, 28 (19%) - 10 GG1 and 18 GG2 - progressed (radiologic n=15, histopathologic n = 3, combined n = 10) and underwent RP within 24 months of trial duration. Median follow-up after RP was 24 months (IQR 15-38). Among 25 patients with ≥12 months follow-up, 92% achieved PSA <0.01 ng/ml at 12 months. BCR occurred in 4 patients (14%), AP in 9 (32%), and 1 patient (3.6%) developed pelvic lymph node metastasis. Gleason Pattern (GP) 4 at biopsy, PI-RADS, and PRECISE scores significantly predicted BCR, while GP4 percentage, percentage of positive cores and PI-RADS predicted AP.Conclusions These findings support the oncological safety of MRI-guided AS in terms of BCR and development of metastases in selected GG1/2 PC patients. However, the rate of AP needs to be acknowledged in patient counseling.
SN - 2080-4806
SN - 2080-4873
ER -