248 ACCURACY OF MULTIPARAMETRIC MAGNETIC RESONANCE PROSTATE IMAGING (MP-MRI) IN CONFIRMING ELIGIBILITY FOR ACTIVE SURVEILLANCE (AS) FOR MEN WITH PROSTATE CANCER (PCA)

Abstract

You have accessJournal of UrologyProstate Cancer: Staging (I)1 Apr 2013248 ACCURACY OF MULTIPARAMETRIC MAGNETIC RESONANCE PROSTATE IMAGING (MP-MRI) IN CONFIRMING ELIGIBILITY FOR ACTIVE SURVEILLANCE (AS) FOR MEN WITH PROSTATE CANCER (PCA) Lambros Stamatakis, M. Minhaj Siddiqui, Jennifer Logan, Jeffrey Nix, Soroush Rais-Bahrami, Annerleim Walton-Diaz, Anthony Hoang, Srinivas Vourganti, Hong Truong, Baris Turkbey, Peter Choyke, Bradford Wood, and Peter Pinto Lambros StamatakisLambros Stamatakis Bethesda, MD More articles by this author , M. Minhaj SiddiquiM. Minhaj Siddiqui Bethesda, MD More articles by this author , Jennifer LoganJennifer Logan Bethesda, MD More articles by this author , Jeffrey NixJeffrey Nix Bethesda, MD More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami Bethesda, MD More articles by this author , Annerleim Walton-DiazAnnerleim Walton-Diaz Bethesda, MD More articles by this author , Anthony HoangAnthony Hoang Bethesda, MD More articles by this author , Srinivas VourgantiSrinivas Vourganti Bethesda, MD More articles by this author , Hong TruongHong Truong Bethesda, MD More articles by this author , Baris TurkbeyBaris Turkbey Bethesda, MD More articles by this author , Peter ChoykePeter Choyke Bethesda, MD More articles by this author , Bradford WoodBradford Wood Bethesda, MD More articles by this author , and Peter PintoPeter Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1628AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While AS attempts to avoid overtreatment of clinically indolent PCa, the method to differentiate patients with clinically significant versus indolent disease remains controversial. Common selection criteria for AS includes a repeat prostate biopsy to confirm the initial pathology. MP-MRI has the potential to detect the presence and volume of PCa. It was the goal of our study to characterize the performance of MP-MRI in confirming AS candidacy. METHODS We reviewed all men who underwent 3.0T MP-MRI with subsequent MRI/US fusion guided prostate biopsy between 2007û2012 and selected patients who met the Johns Hopkins AS criteria at entry based on their initial biopsy. Multiple characteristics seen on MP-MRI were measured including number of lesions, dominant lesion diameter and volume, total lesion volume (sum of the individual lesion volumes), prostate volume, and “lesion density” (calculated as total lesion volume divided by whole prostate volume). Lesions were assigned a low, moderate, or high suspicion for cancer by the radiologist. AS criteria was then reapplied based on the confirmatory biopsy data, and accuracy of MP-MRI in predicting AS candidacy was assessed. Logistic regression modeling and chi-square statistics were used to assess associations between MP-MRI and biopsy results. RESULTS Eighty-six patients qualified for AS with a mean age of 60.4 years and mean PSA of 4.94. Of these, 25 patients (34%) were reclassified as no longer fulfilling AS criteria based on their confirmatory prostate biopsy results. Upon univariate analysis, number of lesions (p = 0.03) and MP-MRI based lesion suspicion for cancer (p = 0.04) were significantly associated with confirmatory biopsy negating AS candidacy. Lesion density approached significance (p = 0.051). These three factors were combined to create a nomogram with good accuracy (AUC 0.7). CONCLUSIONS As urologists counsel patients with newly diagnosed PCa, MP-MRI may contribute to the decision-making process when considering AS. Number of lesions, lesion suspicion, and lesion density were associated with confirmatory biopsy outcome. A nomogram using these three factors has promising predictive accuracy for which future validation is necessary. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e102 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lambros Stamatakis Bethesda, MD More articles by this author M. Minhaj Siddiqui Bethesda, MD More articles by this author Jennifer Logan Bethesda, MD More articles by this author Jeffrey Nix Bethesda, MD More articles by this author Soroush Rais-Bahrami Bethesda, MD More articles by this author Annerleim Walton-Diaz Bethesda, MD More articles by this author Anthony Hoang Bethesda, MD More articles by this author Srinivas Vourganti Bethesda, MD More articles by this author Hong Truong Bethesda, MD More articles by this author Baris Turkbey Bethesda, MD More articles by this author Peter Choyke Bethesda, MD More articles by this author Bradford Wood Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...