Abstract
To evaluate the contribution of multiparametric MRI (MRI) and targeted biopsies (TB) in the selection and follow-up of patients under active surveillance (AS). A single-center, retrospective cohort study on 131patients in AS, with following criteria:≤cT2stage, PSA≤15ng/mL, Gleason score≤6,≤3positive biopsies and maximum tumor length≤5mm. Patients' selection and follow-up was performed by the combination of systemic biopsies (SB) and mpMRI±TB. Reclassification was defined by a Gleason score>6and/or a maximum tumor length>5mm. Overall, 29patients (22.1%) were reclassified. Reclassification free survival rate was 93% and 70% at 1year and 4years respectively. Reclassification independent risk factors were: PSA density>0.15ng/mL/cm3 (RR=2.75), PSA doubling time<3years (RR=9.28), suspicious lesion on MRI diagnosis (RR=2.79) and occurrence of MRI progression during follow-up (RR=2). Sensitivity, specificity, PPV and NPV of MRI to assess progression for reclassification were 61%, 69%, 45% and 81%, respectively. For patients under AS, mpMRI decreases reclassification rates over time through better initial detection of significant cancers. Its high NPV makes it an efficient monitoring tool to distinguish patients with low risk of reclassification. 4.
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