Repeat multiparametric MRI in prostate cancer patients on active surveillance

Abstract

IntroductionThis study was conducted to describe the changes in repeat multiparametric MRI (mpMRI) occurring in prostate cancer (PCa) patients during active surveillance (AS), and to study possible associations between mpMRI-related parameters in predicting prostate biopsy (Bx) Gleason score (GS) upgrading >3+3 and protocol-based treatment change (TC).Materials and methodsThe study cohort consisted of 76 AS patients with GS 3+3 PCa and at least two consecutive mpMRIs of the prostate performed between 2006–2015. Patients were followed according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol and an additional mpMRI. The primary end points were GS upgrading (GU) (>3+3) in protocol-based Bxs and protocol-based TC.ResultsOut of 76 patients, 53 (69%) had progression (PIRADS upgrade, size increase or new lesion[s]), while 18 (24%) had radiologically stable disease, and 5 (7%) had regression (PIRADS or size decrease, disappearance of lesion[s]) in repeat mpMRIs during AS. PIRADS scores of 4–5 in the initial mpMRI were associated with GU (p = 0.008) and protocol-based TC (p = 0.009). Tumour progression on repeat mpMRIs was associated with TC (p = 0.045) but not with GU (p = 1.00). PIRADS scores of 4–5 predict GU (sensitivity 0.80 [95% confidence interval (CI); 0.51–0.95, specificity 0.62 [95% CI; 0.52–0.77]) with PPV and NPV values of 0.34 (95% CI; 0.21–0.55) and 0.93 (95% CI; 0.80–0.98), respectively.ConclusionmpMRI is a useful tool not only to select but also to monitor PCa patients on AS.

Diagnostic accuracy of 68Ga‐prostate‐specific membrane antigen (PSMA) positron‐emission tomography (PET) and multiparametric (mp)MRI to detect intermediate‐grade intra‐prostatic prostate cancer using whole‐mount pathology: impact of the addition of 68Ga‐PSMA PET to mpMRI

“…The concept of using non‐invasive techniques, rather than relying on (repeat) systematic prostate biopsies, to accurately identify men with significant PCa is appealing, however, for this to become a reality, imaging tools must be accurate, demonstrating high sensitivity and specificity to detect significant PCa. Although mpMRI is increasingly being used to diagnose or monitor PCa , because of its relatively low PPV, prostate biopsies are still required. The aim of the present study was to determine whether PSMA‐PET was able to further differentiate between areas containing significant or no/insignificant PCa.…”

MRI in active surveillance: a critical review

“…lesions were mostly benign (with only up to 13.8% harboring low-gradeGleason 6 cancer) and did not change significantly in size over approximately 2 years (2.31±1.56 years and 2.40±1.77 years for ≤7 mm and ≤5 mm index lesion thresholds, respectively). From these findings the authors proposed a monitoring interval of at least two years for small lesions.Studies of men already on AS who have had repeat mpMRIs and biopsies are more informative(39)(40)(41)(42)(43)(44)(45)(Table 2). In a retrospective study, Walton-Diaz and colleagues evaluated patients meeting surveillance criteria based on systematic TRUS biopsy, who subsequently underwent further systematic biopsies, mpMRI and TRUS targeted biopsies during AS until Gleason grade progression occurred and treatment was recommended(39).The sensitivity, specificity, negative and positive predictive values were 0.53 (95% CI: 0.28-0.77), 0.80 (95% CI: 0.65-0.91), 0.80 (95% CI: 0.65-0.91), 0.53 (95% CI: 0.28-0.77), respectively.…”

Prostate MRI added to CAPRA, MSKCC and Partin cancer nomograms significantly enhances the prediction of adverse findings and biochemical recurrence after radical prostatectomy

“…Prostate mpMRI was performed without an endorectal coil using a 3.0 T Philips Achieva MRI scanner, which produced 3-mm thick image slices. The modality included T2WI, DWI with ADC mapping and DCE conforming to European Society of Urogenital Radiology guidelines as previously described [6,13]. The mpMRI data were interpreted by one of the four experienced uroradiologists all of whom were familiar with prostate mpMRI i.e.…”