MP17-01 HETEROGENEITY IN DETECTION RATES OF HIGHER GRADE PROSTATE CANCER BY MULTIPARAMETRIC MRI IN AN ACTIVE SURVEILLANCE COHORT

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II1 Apr 2018MP17-01 HETEROGENEITY IN DETECTION RATES OF HIGHER GRADE PROSTATE CANCER BY MULTIPARAMETRIC MRI IN AN ACTIVE SURVEILLANCE COHORT Mufaddal Mamawala, Patricia Landis, Katarzyna Macura, Jonathan Epstein, and H. Ballentine Carter Mufaddal MamawalaMufaddal Mamawala More articles by this author , Patricia LandisPatricia Landis More articles by this author , Katarzyna MacuraKatarzyna Macura More articles by this author , Jonathan EpsteinJonathan Epstein More articles by this author , and H. Ballentine CarterH. Ballentine Carter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.556AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric magnetic resonance imaging (mpMRI) has been shown to improve sensitivity for detection of higher grade prostate cancer (PCa). However, it′s utility in monitoring men on active surveillance (AS) is still unclear. We hypothesized that the utility of mpMRI would differ across risk strata in men appropriate for AS. METHODS Between 2014 and 2017, we retrospectively identified 449 men with grade group (GG) 1 cancer (median AS follow-up 3 yrs., IQR 2 - 6 yrs.) from the Johns Hopkins AS registry with a mpMRI showing lesion(s) scored in PIRADS v2.0 and a follow-up targeted and/or systematic biopsy within a year. The study cohort was stratified into 4 sub-groups based on biopsy results prior to mpMRI: a) very-low-risk (≤2 positive biopsy cores and ≤50% core involvement, n = 212), b) low-risk (>2 cores or >50% core involvement, n = 237); and based on number of prior prostate biopsies: c) ≤2 biopsies (n = 220), d) >5 biopsies (n = 129). Rates of upgrading to GG≥ 2 (Gleason score ≥ 3+4) on follow-up biopsy were compared across PIRADS scores between each respective risk-subgroup. RESULTS Within each of the 4 sub-groups there was a significant increase in detection rates of GG≥ 2 with increasing PIRADS v2.0 score (all p <0.05). In each PIRADS category, men with low-risk PCa had higher rates of upgrading than men with very-low-risk PCa (15% PIRADS ≤3, 34% PIRADS 4, 48% PIRADS 5 vs. 4% PIRADS ≤3, 10% PIRADS 4, 18% PIRADS 5; p<0.001) [Figure]. Similarly, men with ≤2 biopsies had higher rates of upgrading than men with >5 biopsies (8.0% PIRADS ≤3, 33% PIRADS 4, 50% PIRADS 5 vs. 10% PIRADS ≤3, 13% PIRADS 4, 25% PIRADS 5; p = 0.03). Overall, PIRADS 4/5 had significantly higher detection rates of GG≥ 2 in men with low-risk PCa than with very-low-risk PCa (38% vs. 11%, p <0.001) and also in men with fewer biopsies compared to men with numerous biopsies (37% vs. 17%, p = 0.02). CONCLUSIONS These data suggest heterogeneity in higher-grade cancer detection rates by mpMRI, which is contingent upon patient characteristics of cancer volume (low-risk vs. very-low-risk) and extent of under-sampling (prior number of biopsies). Further evaluation is needed to identify appropriate sub-groups of men in AS where mpMRI may be unnecessary. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e205 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mufaddal Mamawala More articles by this author Patricia Landis More articles by this author Katarzyna Macura More articles by this author Jonathan Epstein More articles by this author H. Ballentine Carter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...