ArticleBJU international2025
Long-term outcomes of active surveillance for Grade Group 1 prostate cancer and the impact of the use of MRI on overtreatment.
Article in BJU international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Association Between Biopsy PD-L1 Combined Positive Score and Pathological Upgrading at Radical Prostatectomy in Grade Group 1 Prostate Cancer: A Retrospective Study.International journal of molecular sciences · 2026Article
- The Proposed Introduction of a Prostate Cancer Screening Program in Germany: Procedure, Necessary Studies before Implementation, Benefits, and Risks.Deutsches Arzteblatt international · 2026Review
- Prostate cancer detection in routine clinical practice: a large cohort study in Japan.Scientific reports · 2026Article
- [Early detection of prostate cancer-recommendations of the updated S3 guideline 2025].Urologie (Heidelberg, Germany) · 2026Review
- Real-world monitoring strategies and predictors guiding the transition from active surveillance to treatment in ISUP 1 prostate cancer.Journal of cancer research and clinical oncology · 2026Article
- Comparable recurrence risk for MRI-detected Gleason Grade Group (GG) 2 and systematic biopsy-detected GG1 prostate cancer.BJU international · 2026Article
- Leveraging MRI to reduce overtreatment in low‑grade prostate cancer: a retrospective single‑centre cohort study.Therapeutic advances in urologyArticle
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Authors and funding
16 authors.
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Abstract
objectivesTo present the long-term outcomes of men with Grade Group (GG) 1 prostate cancer (PCa), included in the Prostate Cancer Research International Active Surveillance (PRIAS) study, and to assess the effect of the inclusion of magnetic resonance imaging (MRI) within the active surveillance (AS) protocol. PATIENTS AND
methodsThe PRIAS study is a multicentre, prospective, web-based cohort study monitoring patients on AS. In total, 8910 men with GG1 PCa were followed in 169 centres worldwide. The cumulative incidences of definitive treatment, metastasis and PCa-specific mortality (PCSM) were estimated using competing risk analyses. Additionally, multivariable analysis was performed to assess the risk of reclassification, stratified by MRI performed around the time of diagnosis.
resultsThe cumulative incidence of definitive treatment 15 years post-diagnosis was 55% (95% confidence interval [CI] 53-57). For metastasis, the 15-year cumulative incidence was 2.7% (95% CI 1.5-4.4). Eight men of died from PCa, resulting in a 15-year cumulative PCSM incidence of 0.23% (95% CI 0.09-0.54). Compared to men with no MRI around the time of diagnosis, those who underwent MRI during the first 18 months of AS were associated with a significantly higher risk of reclassification to ≥GG2, while men with a positive MRI before diagnosis were associated with a higher risk of reclassification to GG2, but not to ≥GG3. Men with GG2 PCa on MRI-targeted rebiopsy who underwent definitive treatment did not show a statistically significant higher risk of 5-year disease recurrence compared to those who had GG1 PCa on last biopsy during AS.
conclusionsOur study confirms the safety of AS for GG1 PCa, with low metastasis and PCSM rates over 15 years. Furthermore, the inclusion of MRI in AS prompts increased detection of GG2, leading to increased treatment rates despite similar short-term risks. To minimise overtreatment, expanding eligibility for AS and the uptake of AS in men with favourable GG2 PCa is crucial to address the stage shift resulting from the increased accuracy of MRI.
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