129 Background: The aim of this study was to determine the feasibility of using mpMRI to monitor/reclassify patients with low grade Prostate Cancer (PCa) undergoing Active Surveillance in a large urology practice. Methods: This is a retrospective study reviewing the records of 28 total patients following active surveillance (AS) protocol. All patients have been diagnosed with biopsy proven prostate cancer (PCa) and have undergone at least one mpMRI as a means of surveillance. The median total PSA of the group at time of diagnosis was 5.93 ng/ml and the mean age of the group was 64 years old. Between the 28 patients, 38 mpMRI tests were conducted, consisting of T2-weighted, diffusion weighted, and dynamic contrast enhanced MRI. Targeted ‘cognitive’ TRUS-MRI guided biopsy was used to locate progression of the PCa and help to determine whether a patient should stay on AS versus choosing more aggressive, definitive treatment. Confirmatory random biopsy was also used to determine overall sensitivity and specificity of the mpMRI conducted for suspicious regions of interest (ROI). Results: The sensitivity and specificity for the group was 65% and 92% respectively. The positive predictive value for the group was 94% while the negative predictive value was 55%. mpMRI was able to detect all clinically significant cancers except in one case. It did not detect some small size lesions (≤5.5mm) of Gleason score 6 that did not have a relevant clinical value. In five of the 28 cases (18%), patients fit the criteria for reclassification (Gleason ≥7, ≥ 3 new positive cores) out of the AS group. Four of these five patients exhibited clear progression of PCa on mpMRI and elected for more aggressive definitive treatment . The progression of cancer in the fifth patient was not seen on mpMRI but only after biopsy. This patient elected to stay in AS because of his advanced age. Conclusions: Despite the limitation of small sample size, mpMRI can be used as an effective diagnostic tool in the AS cohort of a community practice. It can facilitate early detection and progression of suspicious lesion(s) towards clinically significant PCa, thus triggering the start of more aggressive treatment.
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