Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

Abstract

Purpose To evaluate the usefulness of multiparametric magnetic resonance imaging (mpMRI) to avoid misclassification of patients with clinically significant prostate cancer (PCa) into active surveillance (AS). Materials and Methods Patients with Gleason grade group (GG) 1 PCa on systematic biopsy who underwent mpMRI before radical prostatectomy (RP) were included. mpMRI and pathologic results were compared between the AS and NOT-AS candidates. Unfavorable disease was defined as the identification of T3-4 disease or GG upgrade in the RP specimen. We established an ideal cutoff Prostate Imaging Reporting and Data System (PI-RADS) score for predicting unfavorable disease, and analyzed the location of index lesions on mpMRI. Results PI-RADS scores were not significantly different between AS candidates (n=64) and NOT-AS candidates (n=136; p=0.629). Among 64 AS candidates, GG upgrading and unfavorable disease were diagnosed after RP in 24 (37.5%) and 25 (39.1%) patients, respectively. The rate of unfavorable disease was greater for patients with a PI-RADS score of 5 (83.3%) than in those with a score ≤4 (34.5%; p=0.030). Moreover, most PI-RADS 5 lesions in AS candidates were located in the anterior half of the prostate, with GG upgrading on targeted biopsy in 75.0% of cases. Conclusions Among the patients with GG 1 PCa, PI-RADS scores did not differ significantly between AS and NOT-AS candidates. Nonetheless, AS candidates with PI-RADS 5 lesions were diagnosed with unfavorable disease in >80% of RP specimens. Significant cancer located in the anterior half of the prostate including the transitional zone can be missed by systematic biopsy.

Clinicopathologic Significance of Anterior Prostate Cancer

“…12 This study was also hampered by the inclusion of anterior dominant cancers, which may explain the observed higher proportion of anterior tumors in that series. While mpMRI and targeted biopsies significantly improve prostate cancer detection, 21,22 their utilization is not universal-primarily due to cost and, as a consequence, the results between series are not comparable. Some studies do not mention if mpMRI testing was undertaken, 13,16,33 while in another only 24.5% of the patients underwent examination by mpMRI.…”

“…19,20 The advent of multiparametric magnetic resonance image (mpMRI) and targeted prostatic biopsies have significantly improved prostate cancer detection, particularly for tumors located in the anterior prostate. 21,22 This has also provided an opportunity for us to more accurately characterize the prevalence and clinical significance of APC based on a contemporary population of patients with prostate cancer, the vast majority having been assessed with mpMRI.…”

Impact of delay from transperineal biopsy to radical prostatectomy upon objective measures of cancer control

“…Recently, there has been increasing utilisation of magnetic resonance imaging-targeted biopsies, transperineal prostate biopsies (TPBs), and other changes [ 9 , 10 ]. These diagnostic techniques offer superior ability to detect and predict disease [ [11] , [12] , [13] , [14] , [15] ].…”