Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance.

Abstract

INTRODUCTION:

We evaluated the performance of multiparametric prostate magnetic resonance imaging (mp-MRI) and MRI/transrectal ultrasound (TRUS) fusion-guided biopsy (FB) for monitoring patients with prostate cancer on active surveillance (AS).

MATERIALS AND METHODS:

Patients undergoing mp-MRI and FB of target lesions identified on mp-MRI between August 2007 and August 2014 were reviewed. Patients meeting AS criteria (Clinical stage T1c, Gleason grade ≤ 6, prostate-specific antigen density ≤ 0.15, tumor involving ≤ 2 cores, and ≤ 50% involvement of any single core) based on extended sextant 12-core TRUS biopsy (systematic biopsy [SB]) were included. They were followed with subsequent 12-core biopsy as well as mp-MRI and MRI/TRUS fusion biopsy at follow-up visits until Gleason score progression (Gleason ≥ 7 in either 12-core or MRI/TRUS fusion biopsy). We evaluated whether progression seen on mp-MRI (defined as an increase in suspicion level, largest lesion diameter, or number of lesions) was predictive of Gleason score progression.

RESULTS:

Of 152 patients meeting AS criteria on initial SB (mean age of 61.4 years and mean prostate-specific antigen level of 5.26 ng/ml), 34 (22.4%) had Gleason score ≥ 7 on confirmatory SB/FB. Of the 118 remaining patients, 58 chose AS and had at least 1 subsequent mp-MRI with SB/FB (median follow-up = 16.1 months). Gleason progression was subsequently documented in 17 (29%) of these men, in all cases to Gleason 3+4. The positive predictive value and negative predictive value of mp-MRI for Gleason progression was 53% (95% CI: 28%-77%) and 80% (95% CI: 65%-91%), respectively. The sensitivity and specificity of mp-MRI for increase in Gleason were also 53% and 80%, respectively. The number needed to biopsy to detect 1 Gleason progression was 8.74 for SB vs. 2.9 for FB.

CONCLUSIONS:

Stable findings on mp-MRI are associated with Gleason score stability. mp-MRI appears promising as a useful aid for reducing the number of biopsies in the management of patients on AS. A prospective evaluation of mp-MRI as a screen to reduce biopsies in the follow-up of men on AS appears warranted.

• Authors: Annerleim Walton Diaz, Nabeel Ahmad Shakir, Arvin K George, Soroush Rais-Bahrami, Baris Turkbey, Jason T Rothwax, Lambros Stamatakis, Cheng William Hong, Mohummad Minhaj Siddiqui, Chinonyerem Okoro, Dima Raskolnikov, Daniel Su, Joanna Shih, Hui Han, Howard L Parnes, Maria J Merino, Richard M Simon, Bradford J Wood, Peter L Choyke, Peter A Pinto
• Journal: Urologic oncology (Urol Oncol) Vol. 33 Issue 5 Pg. 202.e1-202.e7 (May 2015) ISSN: 1873-2496 [Electronic] United States
• PMID: 25754621 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
• Copyright: Published by Elsevier Inc.

Topics

• Adult
• Aged
• Disease Management
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Prostatic Neoplasms (diagnostic imaging, pathology, radiotherapy)
• Public Health Surveillance
• Retrospective Studies
• Ultrasonography, Interventional (methods)