Utilization of Multiparametric MRI of Prostate in Patients under Consideration for or Already in Active Surveillance: Correlation with Imaging Guided Target Biopsy.

Jinxing Yu,Anna Lee Ware,Nitai D Mukhopadhyay,Ann S Fulcher,Harnek S Bajaj,Christopher Jackson,Sarah Winks,Mary A Turner,Lance J Hampton,Candice Kim,William Behl

doi:10.3390/diagnostics10070441

Abstract

This study sought to assess the value of multiparametric magnetic resonance image (mp-MRI) in patients with a prostate cancer (PCa) Gleason score of 6 or less under consideration for or already in active surveillance and to determine the rate of upgrading by target biopsy. Three hundred and fifty-four consecutive men with an initial transrectal ultrasound-guided (TRUS) biopsy-confirmed PCa Gleason score of 6 or less under clinical consideration for or already in active surveillance underwent mp-MRI and were retrospectively reviewed. One hundred and nineteen of 354 patients had cancer-suspicious regions (CSRs) at mp-MRI. Each CSR was assigned a Prostate Imaging Reporting and Data System (PI-RADS) score based on PI-RADS v2. One hundred and eight of 119 patients underwent confirmatory imaging-guided biopsy for CSRs. Pathology results including Gleason score (GS) and percentage of specimens positive for PCa were recorded. Associations between PI-RADS scores and findings at target biopsy were evaluated using logistic regression. At target biopsy, 81 of 108 patients had PCa (75%). Among them, 77 patients had upgrading (22%, 77 of 354 patients). One hundred and forty-six CSRs in 108 patients had PI-RADS 3 n = 28, 4 n = 66, and 5 n = 52. The upgraded rate for each category of CSR was for PI-RADS 3 (5 of 28, 18%), 4 (47 of 66, 71%) and 5 (49 of 52, 94%). Using logistic regression analysis, differences in PI-RADS scores from 3 to 5 are significantly associated with the probability of disease upgrade (20%, 73%, and 96% for PI-RADS score of 3, 4, and 5, respectively). Adding mp-MRI to patients under consideration for or already in active surveillance helps to identify undiagnosed PCa of a higher GS or higher volume resulting in upgrading in 22%.

Highlights

The aim of active surveillance (AS) is to avoid radical treatment and its side-effects in men who have truly low risk prostate cancer (PCa), whilst offering radical treatment to those men who are at higher risk of local progression or metastatic disease [1]
Using radical prostatectomy specimens as a reference, an excellent performance of multiparametric magnetic resonance image (mp-MRI) was demonstrated in identifying tumors of the peripheral and transition zones [22,23]
The application of this technology has been extended to many clinical indications such as identifying tumors in men with previous benign biopsies and persistently elevated prostate-specific antigen (PSA) levels [24,25]

Summary

Introduction

The aim of active surveillance (AS) is to avoid radical treatment and its side-effects in men who have truly low risk prostate cancer (PCa), whilst offering radical treatment to those men who are at higher risk of local progression or metastatic disease [1]. The traditional tools used to attribute these risk categories are prostate-specific antigen (PSA), digital rectal examination, transrectal ultrasound-guided biopsy (TRUS), and their repeated application over time [2]. None of these tools are sufficiently sensitive or specific to stratify patients. The barrier to acceptance of AS for men with PCa is the risk of underestimating the cancer burden upon initial biopsy. It is important to identify clinically significant PCa in patients who are already in or under consideration for the program of active surveillance

Objectives

Methods

Conclusion