Role of multiparametric 3.0‐Tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance

Abstract

Objective To evaluate predictors of more aggressive disease and the role of multiparametric 3.0‐T magnetic resonance imaging (MRI) in selecting patients with prostate cancer for active surveillance (AS). Patients and Methods We retrospectively assessed 298 patients with prostate cancer who met the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, defined as T1c/T2, PSA level of ≤10 ng/mL, PSA density (PSAD) of <0.2 ng/mL2, Gleason score <7, and one or two positive biopsy cores. All patients underwent preoperative MRI, including T2‐weighted, diffusion‐weighted, and dynamic contrast‐enhanced imaging, as well as radical prostatectomy (RP) between June 2005 and December 2011. Imaging results were correlated with pathological findings to evaluate the ability of MRI to select patients for AS. Results In 35 (11.7%) patients, no discrete cancer was visible on MRI, while in the remaining 263 (88.3%) patients, a discrete cancer was visible. Pathological examination of RP specimens resulted in upstaging (>T2) in 21 (7%) patients, upgrading (Gleason score >6) in 136 (45.6%), and a diagnosis of unfavourable disease in 142 (47.7%) patients. The 263 patients (88.3%) with visible cancer on imaging were more likely to have their cancer status upgraded (49.8% vs 14.3%) and be diagnosed with unfavourable disease (52.1% vs 14.3%) than the 35 patients (11.7%) with no cancer visible upon imaging, and these differences were statistically significant (P < 0.001 for all). A visible cancer lesion on MRI, PSAD, and patient age were found to be predictors of unfavourable disease in multivariate analysis. Conclusion MRI can predict adverse pathological features and be used to assess the eligibility of patients with prostate cancer for AS.

Role of Multi-Parametric Magnetic Resonance Image and PIRADS Score in Patients with Prostate Cancer Eligible for Active Surveillance According PRIAS Criteria

“…MRI has been used with varying levels of effectiveness in an attempt to more accurately stage patients with newly diagnosed PCa. mp-MRI can provide additional information about tissue microvascular properties (dynamic contrast-enhanced imaging, DCEI) and facilitates lesion characterization (diffusion-weighted imaging) [13]. To our knowledge, this is the first study of the prognostic role of mp-MRI and Prostate Imaging Reporting and Data System (PIRADS) score in patients with PRIAS criteria.…”

How Accurate Is Multiparametric MR Imaging in Evaluation of Prostate Cancer Volume?

“…B ecause multiparametric (MP) magnetic resonance (MR) imaging has shown good results in the detection and localization of prostate cancer foci (1)(2)(3)(4)(5), some groups have advocated its use for guiding biopsy (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) or for selecting candidates for active surveillance (21)(22)(23)(24) or focal therapy (25).…”

Threshold-based parametric analysis of diffusion-weighted magnetic resonance imaging at 3.0 Tesla to identify men with prostate cancer

“…A reliable, non-invasive and robust diagnostic tool such as MRI could potentially benefit men with suspected PCa [19,20] . As the majority of significant PCas are visible on DW, potential roles include selection of a suitable area for biopsy and incorporation into an image-guided approach where registration of real-time TRUS images with MRI data allows accurate needle placement, thus eliminating the randomness of TRUS-guided biopsy and increasing the likelihood of positive biopsy [21][22][23] . Although qualitative interpretation of DW images is useful, subjective and has a significant inter-observer variability, it cannot be applied to predict tumor grade [17,24] .…”