Abstract
Currently, multiparametric magnetic resonance imaging (mpMRI) is not an indication for patients with very low-risk prostate cancer. In this study, we aimed to evaluate the usefulness of mpMRI as a diagnostic tool in these patients. We retrospectively analyzed the clinical and pathological data of individuals with very low-risk prostate cancer, according to the NCCN guidelines, who underwent mpMRI before radical prostatectomy at our institution between 2010 and 2016. Patients who did not undergo pre-evaluation with mpMRI were excluded. We analyzed the factors associated with biochemical recurrence (BCR) using Cox regression model, logistic regression analysis, and Kaplan–Meier curve. Of 253 very low-risk prostate cancer patients, we observed 26 (10.3%) with BCR during the follow-up period in this study. The median follow-up from radical prostatectomy was 53 months (IQR 33–74). The multivariate Cox regression analyses demonstrated that the only factor associated with BCR in very low-risk patients was increase in the pathologic Gleason score (GS) (HR: 2.185, p-value 0.048). In addition, multivariate logistic analyses identified prostate specific antigen (PSA) (OR: 1.353, p-value 0.010), PSA density (OR: 1.160, p-value 0.013), and suspicious lesion on mpMRI (OR: 1.995, p-value 0.019) as the independent preoperative predictors associated with the pathologic GS upgrade. In our study, the pathologic GS upgrade after radical prostatectomy in very low-risk prostate cancer patients demonstrated a negative impact on BCR and mpMRI is a good prognostic tool to predict the pathologic GS upgrade. We believe that the implementation of mpMRI would be beneficial to determine the treatment strategy for these patients.
Highlights
Prostate cancer (PCa) is the most common newly diagnosed malignancy in males and its incidence has increased over the past 20 years due to the widespread use of prostate specific antigen (PSA) screening [1]
Clinical characteristics of these patients, including age, body mass index (BMI), preoperative PSA, prostate volume measured by transrectal ultrasound (TRUS), Gleason score (GS) following prostate biopsy, and pathologic characteristics of specimens following Radical prostatectomy (RP) were obtained by review of medical records at our institution
A total of 253 patients, defined as very low-risk PCa according to the NCCN guidelines, were included in the study
Summary
Prostate cancer (PCa) is the most common newly diagnosed malignancy in males and its incidence has increased over the past 20 years due to the widespread use of prostate specific antigen (PSA) screening [1] This trend has increased the diagnosis of localized PCa but a significant decrease in metastatic PCa has been reported [2,3,4]. Several guidelines define low-risk PCa and recommend noninvasive treatment, such as active surveillance for these patients [9,10]. This is to minimize overtreatment in patients.
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