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Does the introduction of prostate multiparametric magnetic resonance imaging into the active surveillance protocol for localized prostate cancer improve patient re‐classification?
Author(s) -
Bryant Richard J.,
Yang Bob,
Philippou Yiannis,
Lam Karla,
Obiakor Maureen,
Ayers Jennifer,
Chiocchia Virginia,
Gleeson Fergus,
MacPherson Ruth,
Verrill Clare,
Sooriakumaran Prasanna,
Hamdy Freddie C.,
Brewster Simon F.
Publication year - 2018
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.14248
Subject(s) - medicine , interquartile range , prostate cancer , prostate , biopsy , magnetic resonance imaging , cohort , prostate biopsy , cancer , radiology , urology , surgery
Objectives To determine whether replacement of protocol‐driven repeat prostate biopsy ( PB ) with multiparametric magnetic resonance imaging (mp MRI ) ± repeat targeted prostate biopsy ( TB ) when evaluating men on active surveillance ( AS ) for low‐volume, low‐ to intermediate‐risk prostate cancer ( PC a) altered the likelihood of or time to treatment, or reduced the number of repeat biopsies required to trigger treatment. Patients and Methods A total of 445 patients underwent AS in the period 2010–2016 at our institution, with a median (interquartile range [ IQR ]) follow‐up of 2.4 (1.2–3.7) years. Up to 2014, patients followed a ‘pre‐2014’ AS protocol, which incorporated PB , and subsequently, according to the 2014 National Institute for Health and Care Excellence ( NICE ) guidelines, patients followed a ‘2014–present’ AS protocol that included mp MRI . We identified four groups of patients within the cohort: ‘no mp MRI and no PB ’; ‘ PB alone’; ‘mp MRI ± TB ’; and ‘ PB and mp MRI ± TB ’. Kaplan–Meier plots and log‐rank tests were used to compare groups. Results Of 445 patients, 132 (30%) discontinued AS and underwent treatment intervention, with a median ( IQR ) time to treatment of 1.55 (0.71–2.4) years. The commonest trigger for treatment was PC a upgrading after mp MRI and TB (43/132 patients, 29%). No significant difference was observed in the time at which patients receiving a PB alone or receiving mp MRI ± TB discontinued AS to undergo treatment (median 1.9 vs 1.33 years; P = 0.747). Considering only those patients who underwent repeat biopsy, a greater proportion of patients receiving TB after mp MRI discontinued AS compared with those receiving PB alone (29/66 [44%] vs 32/87 [37%]; P = 0.003). On average, a single set of repeat biopsies was needed to trigger treatment regardless of whether this was a PB or TB . Conclusions Replacing a systematic PB with mp MRI ± TB as part of an AS protocol increased the likelihood of re‐classifying patients on AS and identifying men with clinically significant disease requiring treatment. mp MRI ± TB as part of AS thereby represents a significant advance in the oncological safety of the AS protocol.