Men with low-risk prostate cancer are often offered active surveillance (AS), sparing them the toxicities of radical therapies and providing them with the opportunity to embark on healthy lifestyle and nutritional strategies. Annual magnetic resonance imaging (MRI) is increasingly being used to help monitor disease progress although its precise role has not been fully established. Hitherto no study has correlated changes in MRI disease status with Prostate Specific Antigen (PSA) dynamics among men managed with AS.
We correlated 346 serum PSA levels with 346 MRIs of 138 men who had at least two prostate MRI scans, and who had prostate cancer managed with AS. All men were given lifestyle information guidance and 102 were also were also taking, long term, a polyphenol rich food supplement following initial recruitment in the UK’s Pomi-t study.
Men with progression seen on MRI had a mean 39.78% rise in PSA (confident interval (CI) 28 to 52%), compared to those whose disease shrunk (-16.05%, CI 14 to -46%), remained stable (1.62% CI -3 to 5%), or was not visualised (-1.62%, CI -14 to 11%) (ANOVA, P-value <0.0001). Of the 142 (68.6%) with paired scans with stable disease 54.1% involved men taking polyphenol rich food supplement as opposed to 14.49% not taking it (chi squared test of p< 0.01).
This strong link between PSA dynamics and MRI tumour progression provides reassurance to men on AS that their PSA dynamics reflect underlying tumour status as seen on MRI, especially in this group keen on lifestyle and nutritional self help strategies.
Keywords: Active surveillance, Multiparametric MRI, Prostate cancer, PSA