Magnetic Resonance Imaging Follow-up of Targeted Biopsy–negative Prostate Lesions

Abstract

BackgroundThe optimal radiological follow-up of prostate lesions negative on magnetic resonance imaging (MRI)-targeted biopsy (MRI-TB) is yet to be optimised. ObjectiveTo present medium-term radiological and clinical follow-up of biopsy-negative lesions. Design, setting, and participantsThe records for men who underwent multiparametric MRI at the UCLH one-stop clinic for suspected prostate cancer between September 2017 and March 2020 were reviewed (n = 1199). Patients with Likert 4 or 5 lesions were considered (n = 495), and those with a subsequent negative MRI-TB comprised the final study population (n = 91). Outcome measurements and statistical analysisBaseline and follow-up MRI and biopsy data (including prostate-specific antigen [PSA], prostate volume, radiological scores, and presence of any noncancerous pathology) were extracted from reports. The last follow-up date was the date of the last test or review in clinic. Results and limitationsMedian follow-up was 1.8 yr (656 d, interquartile range [IQR] 359–1008). At baseline, the median age was 65.4 yr (IQR 60.7–70.0), median PSA was 7.1 ng/ml (IQR 4.7–10.0), median prostate volume was 54 ml (IQR 39.5–75.0), and median PSA density (PSAD) was 0.13 ng/ml2 (IQR 0.09–0.18). Eighty-six men (95%) had Likert 4 lesions, while the remaining five (5%) had Likert 5 lesions. Only 21 men (23%) had a single lesion; most had at least two. Atrophy was the most prevalent pathology on MRI-TB, present in 64 men (74%), and followed by acute inflammation in 42 (46%), prostatic intraepithelial neoplasia in 33 (36%), chronic inflammation in 18 (20%), atypia in 13 (14%), and granulomatous inflammation in three (3%). Fifty-eight men had a second MRI study (median 376 d, IQR 361–412). At the second MRI, median PSAD decreased to 0.11 ng/ml2 (IQR 0.08–0.18). A Likert 4 or 5 score persisted only in five men (9%); 40 men (69%) were scored Likert 3, while the remaining 13 (22%) were scored Likert 2 (no lesion). Of 45 men with a Likert ≥3 score, most only had one lesion at the second MRI (28 men; 62%). Of six men with repeat MRI-TB during the study period, two were subsequently diagnosed with prostate cancer and both had persistent Likert 4 scores (at baseline and at least one follow-up MRI). ConclusionsMost biopsy-negative MRI lesions in the prostate resolve over time, but any persistent lesions should be closely monitored. Patient summaryLesions in the prostate detected via magnetic resonance imaging (MRI) scans that are negative for cancer on biopsy usually resolve. Repeat MRI can indicate persistent lesions that might need a second biopsy.