MP62-01 UNCHANGED NEGATIVE PROSTATE MPMRI DURING ACTIVE SURVEILLANCE. DO WE NEED TO BIOPSY AND FOLLOW-UP?

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (MP62)1 Sep 2021MP62-01 UNCHANGED NEGATIVE PROSTATE MPMRI DURING ACTIVE SURVEILLANCE. DO WE NEED TO BIOPSY AND FOLLOW-UP? Henk Luiting, Antti Rannikko, Chris Bangma, Egbert Boevé, Axel Semjonow, Frédéric Staerman, Karl Tully, Riccardo Valdagni, and Monique Roobol Henk LuitingHenk Luiting More articles by this author , Antti RannikkoAntti Rannikko More articles by this author , Chris BangmaChris Bangma More articles by this author , Egbert BoevéEgbert Boevé More articles by this author , Axel SemjonowAxel Semjonow More articles by this author , Frédéric StaermanFrédéric Staerman More articles by this author , Karl TullyKarl Tully More articles by this author , Riccardo ValdagniRiccardo Valdagni More articles by this author , and Monique RoobolMonique Roobol More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002102.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is ongoing discussion if the negative predictive value of mpMRI during active surveillance (AS) is sufficient to omit prostate biopsies. The next question is, what to do with patients having serial negative MRIs. The AUA guidelines only recommend to perform biopsies within 2 years after diagnosis and do not specify if MRI has a role in preventing unnecessary biopsies during active surveillance. The aim of this study is to add to the current evidence and to evaluate the predictive value of consecutive negative MRIs. METHODS: The PRIAS study is a multicenter prospective study providing an evidence-based recommendation on how to perform AS for patients with low-risk prostate cancer (PCa). The inclusion criteria and recommended follow up schedule are available on www.prias-project.org. All patients with consecutive negative MRIs during AS were included in the current analysis. RESULTS: In total, 180 men had two consecutively negative MRI (negMRI) during AS. The median time between the negMRI was 16 (interquartile range (IQR) 11-25) months. The median PSA at the time of the last negMRI was 6.0 (IQR 4.2-8.6) ng/ml. A total of 68 (38%) men underwent systematic biopsy (SBx) at the last negMRI showing no PCa in 29 patients (43%), PCa grade group (GG) 1 in 35 patients (51%) and PCa GG 2 in 4 patients (6%). Additionally, one patient underwent extraprotocollair PSMA PET/CT targeted prostate biopsies at the time of the last negMRI and was reclassified to PCa GG 3. Follow up data of 158 patients without reclassification at last negMRI who continued AS was available (Figure 1). Median follow up after last negMRI was 21 (IQR 10-34) months. 36 patients underwent additional biopsies of which 10 patients upgraded to GG2 and 3 patients upgraded to GG≥3. All upgrading to GG≥3 was detected by TBx on subsequent MRI. CONCLUSIONS: Patients with repeated negMRI during AS represent a low-risk group, however reclassification to GG2 cannot completely be excluded as, although very rare, reclassification to GG≥3. This questions the need to perform SBx in these patients. Monitoring however, including repeat MRI should continue since progression on the long term cannot be excluded. It is reassuring that all upgrading to GG≥3 was detected on MRI. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1092-e1092 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henk Luiting More articles by this author Antti Rannikko More articles by this author Chris Bangma More articles by this author Egbert Boevé More articles by this author Axel Semjonow More articles by this author Frédéric Staerman More articles by this author Karl Tully More articles by this author Riccardo Valdagni More articles by this author Monique Roobol More articles by this author Expand All Advertisement Loading ...