MRI-informed active surveillance outcomes and dietary fibre acceptability: the Aberdeen experience
- 1The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
Abstract
ObjectivesTo describe active surveillance (AS) outcomes following introduction of an MRI-informed pathway, examine whether baseline PI-RADS/Likert scores identify men with earlier AS discontinuation, and assess the acceptability of dietary fibre supplementation in men on AS.
Patients and methodsWe conducted a retrospective audit of 420 men enrolled in AS at Aberdeen Royal Infirmary between 2012 and 2022. Men were grouped into an MRI-informed pathway (n=198) or biopsy-first pathway (n=222). Time to AS discontinuation for any reason was analysed using Kaplan-Meier methods and log-rank tests. An exploratory analysis compared men with baseline PI-RADS/Likert scores of 4-5 and 2-3. Ten men on AS also completed semi-structured interviews analysed using the Theoretical Framework of Acceptability.
ResultsMedian follow-up was 3.1 years (IQR 1.6-5.1). Overall, 208 men (49.5%) discontinued AS, including 176 because of disease progression. Median time to discontinuation was 4.9 years (95% CI 4.4-5.6). It was shorter in the MRI-informed pathway than in the biopsy-first pathway (4.1 vs 5.6 years; log-rank p<0.01). Among 167 men with recorded baseline MRI scores, 44 (26.3%) had PI-RADS/Likert 4-5. Median time to discontinuation was 2.9 years in this group compared with 4.0 years for scores 2-3 (p<0.01). Interview participants were generally willing to consider dietary fibre supplementation, although gastrointestinal effects and study procedures were anticipated burdens.
ConclusionAS discontinuation occurred earlier in the MRI-informed pathway, although differences in patient selection and surveillance practice should be considered when interpreting this finding. PI-RADS/Likert 4-5 identified a sizeable subgroup with earlier all-cause AS discontinuation that may help inform recruitment to future intervention studies. Dietary fibre supplementation was acceptable in principle, supporting further feasibility work.
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BibTeX
@misc{sescu2026mriinformed,
title = {{MRI-informed active surveillance outcomes and dietary fibre acceptability: the Aberdeen experience}},
author = {D. Sescu and J. Zbikowski and J. S. Royle and S. MacLennan and A. Kiltie},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.24.26363863},
url = {https://www.medrxiv.org/content/10.64898/2026.09.24.26363863v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - MRI-informed active surveillance outcomes and dietary fibre acceptability: the Aberdeen experience
AU - D. Sescu
AU - J. Zbikowski
AU - J. S. Royle
AU - S. MacLennan
AU - A. Kiltie
PY - 2026
DA - 2026/09/24
PB - medRxiv
DO - 10.64898/2026.09.24.26363863
UR - https://www.medrxiv.org/content/10.64898/2026.09.24.26363863v1
AB - ObjectivesTo describe active surveillance (AS) outcomes following introduction of an MRI-informed pathway, examine whether baseline PI-RADS/Likert scores identify men with earlier AS discontinuation, and assess the acceptability of dietary fibre supplementation in men on AS. Patients and methodsWe conducted a retrospective audit of 420 men enrolled in AS at Aberdeen Royal Infirmary between 2012 and 2022. Men were grouped into an MRI-informed pathway (n=198) or biopsy-first pathway (n=222). Time to AS discontinuation for any reason was analysed using Kaplan-Meier methods and log-rank tests. An exploratory analysis compared men with baseline PI-RADS/Likert scores of 4-5 and 2-3. Ten men on AS also completed semi-structured interviews analysed using the Theoretical Framework of Acceptability. ResultsMedian follow-up was 3.1 years (IQR 1.6-5.1). Overall, 208 men (49.5%) discontinued AS, including 176 because of disease progression. Median time to discontinuation was 4.9 years (95% CI 4.4-5.6). It was shorter in the MRI-informed pathway than in the biopsy-first pathway (4.1 vs 5.6 years; log-rank p<0.01). Among 167 men with recorded baseline MRI scores, 44 (26.3%) had PI-RADS/Likert 4-5. Median time to discontinuation was 2.9 years in this group compared with 4.0 years for scores 2-3 (p<0.01). Interview participants were generally willing to consider dietary fibre supplementation, although gastrointestinal effects and study procedures were anticipated burdens. ConclusionAS discontinuation occurred earlier in the MRI-informed pathway, although differences in patient selection and surveillance practice should be considered when interpreting this finding. PI-RADS/Likert 4-5 identified a sizeable subgroup with earlier all-cause AS discontinuation that may help inform recruitment to future intervention studies. Dietary fibre supplementation was acceptable in principle, supporting further feasibility work.
ER -