title: Image-based monitoring of targeted biopsy-proven prostate cancer on active surveillance: 11-year experience.
abstract: OBJECTIVE
  To report our 11-year experience of Active Surveillance (AS) program focusing on modern transrectal ultrasound (TRUS)-based monitoring of targeted biopsy-proven cancer lesion.
  
  
  METHODS
  Consecutive patients on AS, who had targeted biopsy-proven lesion followed by at least a repeat surveillance biopsy and three times TRUS monitoring of the identical visible lesion, were included. Doppler grade of blood flow signal within the lesion was classified from grade 0 to 3. Biopsy-proven progression was defined as upgrade of Gleason score or 25% or greater increase in cancer core involvement.
  
  
  RESULTS
  Fifty patients were included in this study. Clinical variables (median) included age (61 years), clinical stage (T1c, 42;T2, 8), PSA (4.6 ng/ml), and Gleason score (3 + 3, n = 41;3 + 4, n = 9). Of the 50 patients, 34 demonstrated pathological progression at a median follow-up of 4.4 years. In comparing between without (n = 16) and with (n = 34) pathological progression, there were significant differences in cancer core involvement at entry (p = 0.003), the major axis diameter (p = 0.001) and minor axis diameter (p = 0.001) of the visible lesion at entry, increase in the major axis diameter (p = 0.005) and minor axis diameter (p = 0.013), and upgrade of Doppler grade (p < 0.0001). In multivariate analysis for predicting pathological progression, the increase (≥25%) in diameter of biopsy-proven lesion (hazard ratio, 15.314; p = 0.023) and upgrade of Doppler grade (hazard ratio, 37.409; p = 0.019) were significant risk factors.
  
  
  CONCLUSIONS
  Longitudinal monitoring of the TRUS-visible biopsy-proven cancer provides a new opportunity to perform per-lesion-based AS. The increase in diameter and upgrade of Doppler grade of the lesion were significant risk factors for biopsy-proven progression on AS.
authors.affiliation: Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.|Department of Urology, Tokai University Hachioji Hospital, Hachioji, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Shoji
authors.affiliation: Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA. ukimura@usc.edu.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
authors.affiliation: Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Andre Luis
authors.initials: AL
authors.lastname: de Castro Abreu
authors.affiliation: Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Marien
authors.affiliation: Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Toru
authors.initials: T
authors.lastname: Matsugasumi
authors.affiliation: Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Duke
authors.initials: D
authors.lastname: Bahn
authors.affiliation: Center for Prostate Cancer Focal Therapy, Keck School of Medicine, USC Institute of Urology, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D019160:Endosonography / Q000379:methods*; D005544:Forecasting; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012007:Rectum; D015203:Reproducibility of Results; D015996:Survival Rate / Q000639:trends
keywords: Active surveillance; Biopsy; Imaging; Prostate cancer; Transrectal ultrasound