Con: Magnetic Resonance Imaging Targeting Leads to Overtreatment of Prostate Cancer

Siddiqui, Mohummad Minhaj

doi:10.1097/ju.0000000000002777

Cited by 1 publication

(2 citation statements)

References 13 publications

(16 reference statements)

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“…The question if an MRI can lead to overtreatment is as important as the question if a pre-biopsy MRI could lead to overtreatment of cancers. 22,23 Our study has some limitations. Since we used the files of patients that were treated, it was somehow expected to find more clinically significant lesions than in a population of patients on active surveillance or before a diagnostic biopsy.…”

Section: Discussionmentioning

confidence: 93%

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Findings on Diagnostic Magnetic Resonance Imaging Before Radiotherapy for Prostate Cancer

et al. 2022

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Purpose Pre-treatment diagnostic magnetic resonance imaging (MRI) is used in prostate cancer detection and staging; however, little is known about its potential for radiotherapy treatment decision, or its prognostic value. We investigated the findings on pre-treatment MRI and its potential influence on treatment decisions, and its ability to predict biochemical recurrence in patients treated with radiotherapy. Methods Files of patients treated by radiotherapy from 2014 to 2022 were searched for if they had had an MRI within 12 months before radiotherapy. Prostate Imaging Reporting & Data System (PI-RADS) score, index lesion diameter and the presence of organ confined disease or extra-prostatic extension were correlated with their Cancer of the Prostate Risk Assessment (CAPRA) score. Distribution of radiological and clinical features between groups were estimated using a chi-squared test. Results Out of 1280 patients, 314 (24.5%) had an MRI. The distribution depended on the treatment received: 22.5% who received low-dose rate (LDR) brachytherapy as monotherapy, 24.0% treated with high-dose rate (HDR) boost and 32.0% treated with external-beam radiotherapy (EBRT) ( P = .017). The CAPRA score significantly correlated with the PI-RADS score (r = .342, P < .01) and the diameter of the index lesion (r = .473, P < .01). A clinically significant number of 22% patients with CAPRA ≤ 3 disease presented with lesions ≥15 mm and were less likely to be treated with LDR monotherapy ( P < .01). 39 patients had a recurrence, only 5 had an MRI: 4 had a lesion of ≥20 mm and 3 a seminal vesicle invasion. Conclusion More than twenty percent of patients with CAPRA ≤3 presented on MRI a ≥15 mm lesion. An MRI could potentially affect treatment choice, and although exploratory our results suggest an important prognostic potential.

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Section: Discussionmentioning

confidence: 93%

“…The question if an MRI can lead to overtreatment is as important as the question if a pre-biopsy MRI could lead to overtreatment of cancers. 22,23…”

Section: Discussionmentioning

confidence: 99%