MP38-17 CLINICOPATHOLOGIC CHARACTERISTICS OF PATIENTS WITH VERY LOW-RISK (PI-RADS 1 OR 2) LESIONS BY MULTIPARAMETRIC PROSTATE MAGNETIC RESONANCE IMAGING

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2017MP38-17 CLINICOPATHOLOGIC CHARACTERISTICS OF PATIENTS WITH VERY LOW-RISK (PI-RADS 1 OR 2) LESIONS BY MULTIPARAMETRIC PROSTATE MAGNETIC RESONANCE IMAGING Aaron Udager, Joel Friedman, Nicole Curci, John Wei, Chandy Ellimoottil, Rohit Mehra, Scott Tomlins, Jeffrey Montgomery, Matthew Davenport, Angela Wu, and Lakshmi Kunju Aaron UdagerAaron Udager More articles by this author , Joel FriedmanJoel Friedman More articles by this author , Nicole CurciNicole Curci More articles by this author , John WeiJohn Wei More articles by this author , Chandy EllimoottilChandy Ellimoottil More articles by this author , Rohit MehraRohit Mehra More articles by this author , Scott TomlinsScott Tomlins More articles by this author , Jeffrey MontgomeryJeffrey Montgomery More articles by this author , Matthew DavenportMatthew Davenport More articles by this author , Angela WuAngela Wu More articles by this author , and Lakshmi KunjuLakshmi Kunju More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1170AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric prostate magnetic resonance imaging (mpMRI) utilizing the PI-RADS classification system attempts to identify clinically-significant [Gleason score (GS) 7 or higher] prostate cancer (PCa), with PI-RADS 1 or 2 typically corresponding to very low risk of clinically-significant PCa. In this study, we analyzed the clinicopathologic characteristics of patients undergoing prostate core biopsy (PBx) with PI-RADS 1 or 2 lesions. METHODS All patients at a single large academic institution who had at most PI-RAD 1 or 2 lesions on mpMRI between 1/1/15 and 6/30/16 and underwent pre- or post-MRI PBx were retrospectively identified. All cases of clinically-significant PCa were re-reviewed by study pathologists to confirm pathologic findings; clinicopathologic data from all other cases was obtained from pathology reports and electronic medical records. RESULTS 276 patients with PI-RADS 1 or 2 lesions were identified, of which 98 (35.5%) had either pre- (60) or post-MRI (38) in-house PBx. Six (6.1%) patients showed GS7 PCa (3 pre- and 3 post-MRI), including 2 with GS4+3=7 tumors. For the remaining patients, the most recent PBx findings included: GS6 PCa (22 pre- and 13 post-MRI); atypical glands (3 pre- and 2 post-MRI); high-grade prostatic intraepithelial neoplasia (5 pre- and 4 post-MRI); or, benign (27 pre- and 16 post-MRI). For patients with GS7 PCa, the median number of involved cores was 1 (range = 1-3), the median number of total cores was 20 (range = 12-30), the median % involvement of a single core was 12.5 (range = 5-25), and the median % Gleason pattern 4 was 30 (range = 5-90); types of Gleason pattern 4 included: poorly-formed glands only (4), cribriform glands only (1), or poorly-formed and cribriform glands (1). One GS7 tumor occurred in the post-radiation (XRT) setting, and one showed aberrant p63 expression; follow-up for patients with GS7 PCa included primary XRT (1), salvage XRT (1), and active surveillance (AS; 4). Nearly all patients (>90%) with GS6 PCa opted for AS; one patient underwent radical prostatectomy (pT2a GS6 PCa), and one patient was lost to follow-up. CONCLUSIONS The majority (58.2%) of patients with PI-RADS 1 or 2 lesions by mpMRI do not have detectable PCa on core biopsy, however, a small subset (6.1%) harbor GS7 PCa. Although long-term follow-up data are needed, PCa patients with PI-RADS 1 or 2 lesions by mpMRI appear to represent a very low-risk cohort that may be amenable to AS in the majority of cases. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e491 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Aaron Udager More articles by this author Joel Friedman More articles by this author Nicole Curci More articles by this author John Wei More articles by this author Chandy Ellimoottil More articles by this author Rohit Mehra More articles by this author Scott Tomlins More articles by this author Jeffrey Montgomery More articles by this author Matthew Davenport More articles by this author Angela Wu More articles by this author Lakshmi Kunju More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...