Multiparametric magnetic resonance imaging and follow‐up to avoid prostate biopsy in 4259 men

Abstract

Objective To determine the proportion of men avoiding biopsy because of negative multiparametric magnetic resonance imaging (mpMRI) findings in a prostate MRI expert centre, and to assess the number of clinically significant prostate cancers (csPCa) detected during follow‐up. Patients and methods Retrospective study of 4259 consecutive men having mpMRI of the prostate between January 2012 and December 2017, with either a history of previous negative transrectal ultrasonography‐guided biopsy or biopsy naïve. Patients underwent mpMRI in a referral centre. Lesions were classified according to Prostate Imaging Reporting And Data System (PI‐RADS) versions 1 and 2. Negative mpMRI was defined as an index lesion PI‐RADS ≤2. Follow‐up until 13 October 2018 was collected by searching the Dutch Pathology Registry (PALGA). Gleason score ≥3 + 4 was considered csPCa. Kaplan–Meier analysis and univariable logistic regression models were used in the cohort of patients with negative mpMRI and follow‐up. Results Overall, in 53.6% (2281/4259) of patients had a lesion classified as PI‐RADS ≤2. In 320 patients with PI‐RADS 1 or 2, follow‐up mpMRI was obtained after a median (interquartile range) of 57 (41–63) months. In those patients, csPCa diagnosis‐free survival (DFS) was 99.6% after 3 years. Univariable logistic regression analysis revealed age as a predictor for csPCa during follow‐up (P < 0.05). In biopsied patients, csPCa was detected in 15.8% (19/120), 43.2% (228/528) and 74.5% (483/648) with PI‐RADS 3, 4 and 5, respectively. Conclusion More than half of patients having mpMRI of the prostate avoided biopsy. In those patients, csPCa DFS was 99.6% after 3 years.

Expected impact of MRI-related interreader variability on ProScreen prostate cancer screening trial: a pre-trial validation study

“…Panebianco V et al showed that csPCa diagnosis free survival (DFS) was 95% after 2 years follow-up [24]. Furthermore, a recent analysis from another cohort largely corroborate this finding by reporting a csPCa DFS of 99.6% after 3 years [25]. In terms of the ProScreen trial this is reassuring as screen positive men (PSA > 3 and 4 K > 7.5%) with a nMRI or negative targeted biopsy are rescreened after 2 years.…”

Avoiding biopsy in men with PI‐RADS scores 1 and 2 on multiparametric MRI of the prostate, ready for prime time?

“…In this journal, Venderink et al. suggest that more than half the men being investigated for suspected prostate cancer could indeed safely avoid an initial biopsy. However, like other investigators in this field, the authors make an assumption in their study that there is such a paucity of clinically significant cancer in men with PI‐RADS 1 and 2 lesions, that biopsy is not deemed necessary, as in the PRECISION study .…”

BJUI Compass and open access

“…In keeping with our continued theme of the highest quality, clinically relevant papers, in this issue of the BJUI we present two MRI-based prostate cancer papers, showing that while we could avoid biopsies in many men without missing significant disease [5], in African-American men on active monitoring, the cancers can be upgraded more frequently and careful follow-up is thus warranted [6].…”