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Value of 3‐Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance
Author(s) -
Pessoa Rodrigo R.,
Viana Publio C.,
Mattedi Romulo L.,
Guglielmetti Giuliano B.,
Cordeiro Mauricio D.,
Coelho Rafael F.,
Nahas William C.,
Srougi Miguel
Publication year - 2017
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.13624
Subject(s) - medicine , prostate cancer , biopsy , radiology , magnetic resonance imaging , prostate , transrectal ultrasonography , prostate biopsy , cohort , logistic regression , univariate analysis , multivariate analysis , cancer , urology
Objective To evaluate the role of multiparametric magnetic resonance imaging (mp MRI ) of the prostate and transrectal ultrasonography guided biopsy ( TRUS ‐Bx) with visual estimation in early risk stratification of patients with prostate cancer on active surveillance ( AS ). Patients and Methods Patients with low‐risk, low‐grade, localised prostate cancer were prospectively enrolled and submitted to a 3‐T 16‐channel cardiac surface coil mp MRI of the prostate and confirmatory biopsy ( CB x), which included a standard biopsy ( SB x) and visual estimation‐guided TRUS ‐Bx. Cancer‐suspicious regions were defined using Prostate Imaging Reporting and Data System ( PI ‐ RADS ) scores. Reclassification occurred if CB x confirmed the presence of a Gleason score ≥7, greater than three positive fragments, or ≥50% involvement of any core. The performance of mp MRI for the prediction of CB x results was assessed. Univariate and multivariate logistic regressions were performed to study relationships between age, prostate‐specific antigen ( PSA ) level, PSA density ( PSAD ), number of positive cores in the initial biopsy, and mp MRI grade on CB x reclassification. Our report is consistent with the Standards of Reporting for MRI ‐targeted Biopsy Studies ( START ) guidelines. Results In all, 105 patients were available for analysis in the study. From this cohort, 42 (40%) had PI ‐ RADS 1, 2, or 3 lesions and 63 (60%) had only grade 4 or 5 lesions. Overall, 87 patients underwent visual estimation TRUS ‐Bx. Reclassification among patients with PI ‐ RADS 1, 2, 3, 4, and 5 was 0%, 23.1%, 9.1%, 74.5%, and 100%, respectively. Overall, mp MRI sensitivity, specificity, positive predictive value, and negative predictive value for disease reclassification were 92.5%, 76%, 81%, and 90.5%, respectively. In the multivariate analysis, only PSAD and mp MRI remained significant for reclassification ( P < 0.05). In the cross‐tabulation, SB x would have missed 15 significant cases detected by targeted biopsy, but SB x did detect five cases of significant cancer not detected by targeted biopsy alone. Conclusion Multiparametric magnetic resonance imaging is a significant tool for predicting cancer severity reclassification on CB x among AS candidates. The reclassification rate on CB x is particularly high in the group of patients who have PI ‐ RADS grades 4 or 5 lesions. Despite the usefulness of visual‐guided biopsy, it still remains highly recommended to retrieve standard fragments during CB x in order to avoid missing significant tumours.