PD17-08 IMPACT OF SERIAL PROSTATE MULTIPARAMETRIC MRI ON TREATMENT FREE SURVIVAL IN MEN ON ACTIVE SURVEILLANCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD17)1 Sep 2021PD17-08 IMPACT OF SERIAL PROSTATE MULTIPARAMETRIC MRI ON TREATMENT FREE SURVIVAL IN MEN ON ACTIVE SURVEILLANCE Joshua Harvey, Andrew Gusev, Jeffrey Twum-Ampofo, Alberto Pieretti, Florian Rumpf, Alice Yu, Keyan Salari, Douglas Dahl, and Adam Feldman Joshua HarveyJoshua Harvey More articles by this author , Andrew GusevAndrew Gusev More articles by this author , Jeffrey Twum-AmpofoJeffrey Twum-Ampofo More articles by this author , Alberto PierettiAlberto Pieretti More articles by this author , Florian RumpfFlorian Rumpf More articles by this author , Alice YuAlice Yu More articles by this author , Keyan SalariKeyan Salari More articles by this author , Douglas DahlDouglas Dahl More articles by this author , and Adam FeldmanAdam Feldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001999.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate multiparametric magnetic resonance imaging (mpMRI) is increasingly utilized in the risk stratification of men with prostate cancer (PCa). During Active Surveillance (AS) men often receive multiple mpMRIs, yet how the findings impact their cancer outcomes is not well described. We investigated our AS cohort to assess the outcomes of men who underwent at least two prostate mpMRIs during AS METHODS: We reviewed our institutional database of 1252 men enrolled in AS for localized PCa from 1996-2016. We identified 205 men who underwent at least two prostate mpMRIs during AS. MRIs without a reported Prostate Imaging Reporting and Data System (PIRADS) version 2.0 score were excluded. Radiologic progression was defined as new lesion (PIRADS ≥ 3) on a previously negative MRI or increase in PIRADS score of a previous lesion. Multivariate logistic regression was used to evaluate if PIRADS score from serial MRI was a predictor of progression to treatment on AS. Covariates adjusted for included age, NCCN risk group, PSA density, and PIRADS score on initial MRI. A Cox proportional hazards model with PIRADS scores as time-dependent variables was used to evaluate the impact of each PIRADS score during AS on patient treatment free survival (TFS). Survival analyses were conducted using the Kaplan-Meier method. RESULTS: Median values for the cohort of 205 men were as follows: number of MRIs meeting criteria: 2 (range 2-3); follow up time: 5.1 years (IQR 3.7-7.7); time between MRIs: 2 years (IQR 1.5-2.8). On MRI 1, 10% of patients had PIRADS 3 lesions, 19% PIRADS 4, 6% PIRADS 5, while 65% were negative. On repeat MRI, 62% of PIRADS scores did not change, while 27% increased and 11% decreased. Compared to lesions that remained the same, PIRADS increase was an independent predictor of progression to treatment (OR 9.0, 95% CI 3.8-21.4, p<0.001). PIRADS decrease was not a significant predictor of outcomes, yet a negative result on repeat MRI was an independent predictor of reduced progression to treatment (OR 0.16, 95% CI 0.07-0.37, p<0.001). Overall, men with negative MRIs on AS experienced prolonged TFS compared to those with PIRADS 5 lesions, with 85% vs 48% remaining on surveillance at 5 years, respectively. CONCLUSIONS: While a majority of men did not experience PIRADS score change on serial prostate mpMRI, radiologic progression was an independent predictor of increased AS failure and progression to treatment. Men with serial negative MRIs on AS have significantly prolonged TFS and may be candidates for an increased interval between surveillance MRI and biopsy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e287-e288 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Harvey More articles by this author Andrew Gusev More articles by this author Jeffrey Twum-Ampofo More articles by this author Alberto Pieretti More articles by this author Florian Rumpf More articles by this author Alice Yu More articles by this author Keyan Salari More articles by this author Douglas Dahl More articles by this author Adam Feldman More articles by this author Expand All Advertisement Loading ...