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Role of multiparametric 3.0‐ T esla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance
Author(s) -
Park Bong H.,
Jeon Hwang G.,
Choo Seol H.,
Jeong Byong C.,
Seo Seong I.,
Jeon Seong S.,
Choi Han Y.,
Lee Hyun M.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12423
Subject(s) - prostate cancer , medicine , prostatectomy , magnetic resonance imaging , pathological , cancer , biopsy , radiology , prostate , oncology , urology
Objective To evaluate predictors of more aggressive disease and the role of multiparametric 3.0‐ T magnetic resonance imaging ( MRI ) in selecting patients with prostate cancer for active surveillance ( AS ).Patients and Methods We retrospectively assessed 298 patients with prostate cancer who met the Prostate Cancer Research International: Active Surveillance ( PRIAS ) criteria, defined as T 1c/ T 2, PSA level of ≤10 ng/mL, PSA density ( PSAD ) of <0.2 ng/mL 2 , G leason score <7, and one or two positive biopsy cores. All patients underwent preoperative MRI , including T 2‐weighted, diffusion‐weighted, and dynamic contrast‐enhanced imaging, as well as radical prostatectomy ( RP ) between J une 2005 and D ecember 2011. Imaging results were correlated with pathological findings to evaluate the ability of MRI to select patients for AS .Results In 35 (11.7%) patients, no discrete cancer was visible on MRI , while in the remaining 263 (88.3%) patients, a discrete cancer was visible. Pathological examination of RP specimens resulted in upstaging (> T 2) in 21 (7%) patients, upgrading ( G leason score >6) in 136 (45.6%), and a diagnosis of unfavourable disease in 142 (47.7%) patients. The 263 patients (88.3%) with visible cancer on imaging were more likely to have their cancer status upgraded (49.8% vs 14.3%) and be diagnosed with unfavourable disease (52.1% vs 14.3%) than the 35 patients (11.7%) with no cancer visible upon imaging, and these differences were statistically significant ( P < 0.001 for all). A visible cancer lesion on MRI , PSAD , and patient age were found to be predictors of unfavourable disease in multivariate analysis.ConclusionMRI can predict adverse pathological features and be used to assess the eligibility of patients with prostate cancer for AS .