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Multiparametric magnetic resonance imaging facilitates reclassification during active surveillance for prostate cancer
Author(s) -
Fujihara Atsuko,
Iwata Tsuyoshi,
Shakir Aliasger,
Tafuri Alessandro,
Cacciamani Giovanni E.,
Gill Karanvir,
Ashrafi Akbar,
Ukimura Osamu,
Desai Mihir,
Duddalwar Vinay,
Stern Mariana S.,
Aron Manju,
Palmer Suzanne L.,
Gill Inderbir S.,
Abreu Andre Luis
Publication year - 2021
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.15272
Subject(s) - medicine , prostate cancer , magnetic resonance imaging , prostate , cohort , biopsy , prostate specific antigen , radiology , institutional review board , cancer , urology , nuclear medicine , surgery
Objective To investigate the utility of multiparametric magnetic resonance imaging (mpMRI) in the reassessment and monitoring of patients on active surveillance (AS) for Grade Group (GG) 1 prostate cancer (PCa). Patients and Methods We identified, from our prospectively maintained institutional review board‐approved database, 181 consecutive men enrolled on AS for GG 1 PCa who underwent at least one surveillance mpMRI followed by MRI/prostate biopsy (PBx). A subset analysis was performed among 68 patients who underwent serial (at least two) mpMRI/PBx during AS. Pathological progression (PP) was defined as upgrade to GG ≥2 on follow up biopsy. Results Baseline MRI was performed in 34 patients (19%). At a median follow‐up of 2.2 years for the overall cohort, the PP was 12% (6/49) for Prostate Imaging Reporting and Data System (PI‐RADS) 1–2 lesions and 37% (48/129) for the PI‐RADS ≥3 lesions. The 2‐year PP‐free survival rate was 84%. Surveillance prostate‐specific antigen density ( P < 0.001) and surveillance PI‐RADS ≥3 ( P = 0.002) were independent predictors of PP on reassessment MRI/PBx. In the serial MRI cohort, the 2‐year PP‐free survival was 95% for the No‐MRI‐progression group vs 85% for the MRI‐progression group ( P = 0.02). MRI progression was significantly higher in the PP (62%) than in the No‐PP (31%) group ( P = 0.04). If serial MRI were used for PCa surveillance and biopsy were triggered based only on MRI progression, 63% of PBx might be postponed at the cost of missing 12% of GG ≥2 PCa in those with stable MRI. Conversely, this strategy would miss 38% of those with upgrading to GG ≥2 PCa on biopsy. Stable serial mpMRI correlates with no reclassification to GG ≥3 PCa during AS. Conclusion On surveillance mpMRI, PI‐RADS ≥3 was associated with increased risk of PCa reclassification. Surveillance biopsy based only on MRI progression may avoid a large number of biopsies at the cost of missing many PCa reclassifications.