The Role of MRI in Active Surveillance for Prostate Cancer

Fascelli, Michele; George, Arvin; Frye, Thomas; Türkbey, Barış; Choyke, Peter L.; Pinto, Peter A.

doi:10.1007/s11934-015-0507-9

Cited by 44 publications

(33 citation statements)

References 57 publications

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“…Instead we have been dependent on systematic biopsies carried out in relatively blind fashion, PSA kinetics and digital rectal exam (1,2,5,14,15). Multiparametric MRI, however, has dramatically shifted this paradigm, and is allowing us now to assess tumor burden more accurately, and target lesions for biopsy that were previously not appreciated by available clinical tools (1,15,16) With the increased use of MRI in prostate cancer detection and in men on active surveillance, serial imaging of the prostate is becoming a more common clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Ghavimi

Abdi

Waterhouse

et al. 2018

CUAJ

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Introduction: The natural history of prostatic lesions identified on multiparametric magnetic resonance imaging (mpMRI) is largely unknown. We aimed to describe changes observed over time on serial MRI. Methods: All patients with ≥2 MRI studies between 2008 and 2015 at our institution were identified. MRI progression was defined as an increase in Prostate Imaging Reporting and Data System (PI-RADS; version 2) or size of existing lesions, or the appearance of a new lesion PIRADS ≥4. Patients on active surveillance (AS) were analyzed for correlation of MRI progression to biopsy reclassification. Results: A total of 83 patients (54 on AS and 29 for diagnostic purposes) underwent serial MRI, with a mean interval of 1.9 years between scans. At baseline, 115 lesions (66 index, 49 non-index) were identified. Index lesions were more likely than non-index lesions to increase in size ≥2 mm (36.2 vs. 7.3 %; p=0.002). Overall progression was more likely to be seen among the index cohort (34.8 vs. 7.6%; p<0.001). New lesions with PIRADS ≥4 were seen on second imaging in 13 (16.5%) men, and became the index lesion in 29 cases (34.9%). Eighteen men on AS showed evidence of MRI progression (five with new lesions, 13 with progression of a previous lesion). Biopsy reclassification was present in three men (16.7%) with and seven men without MRI progression (19.4%). Conclusions: Overall changes in size and PIRADS scores of index lesions on MRI were small. New lesions were common, but usually did not alter management.

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Section: Discussionmentioning

confidence: 99%

Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Ghavimi

Abdi

Waterhouse

et al. 2018

CUAJ

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“…Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value of mpMRI in diagnosing significant PCa were 95.2, 100, 93.8, 83.4, 100 %, respectively. prostate [6][7][8]; therefore, many authors suggest including mpMRI in AS follow-up [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?

et al. 2015

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“…MpMRI and consecutive targeted biopsy have shown a good accuracy in diagnosing clinically significant PCa [11,20,21]. Furthermore, mpMRI detects tumour-suspicious lesions with a high sensitivity [5,8].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

Borkowetz¹,

Renner²,

Platzek³

et al. 2018

Urol Int

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Introduction: Targeted biopsy of tumour-suspicious lesions detected in multiparametric magnetic resonance imaging (mpMRI) plays an increasing role in the active surveillance (AS) of patients with low-risk prostate cancer (PCa). The aim of this study was to compare MRI/ultrasound-fusion biopsy (fusPbx) with systematic biopsy (sysPbx) in patients undergoing biopsy for AS. Methods: Patients undergoing mpMRI and transperineal fusPbx combined with transrectal sysPbx (comPbx) as surveillance biopsy were investigated. The detection of Gleason score upgrading and reclassification according to Prostate Cancer Research International Active Surveillance criteria were evaluated. Results: Eighty-three patients were enrolled. PCa upgrading was detected in 39% by fusPbx and in 37% by sysPbx (p = 1.0). The percentage of patients who were reclassified in fusPbx and sysPbx (p = 0.45) were 64 and 59% respectively. ComPbx detected more frequently tumour upgrading than fusPbx (71 vs. 64%, p = 0.016) and sysPbx (71 vs. 59%, p < 0.001) and more patients had to be reclassified after comPbx than after fusPbx or sysPbx alone. Conclusions: The combination of fusPbx and sysPbx outperforms both modalities alone with regard to the detection of upgrading and reclassification in patients under AS. Because a high missing rate of significant PCa still exists in both biopsy modalities, a combination of fusPbx and sysPbx should be recommended in these patients.

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The Role of MRI in Active Surveillance for Prostate Cancer

Cited by 44 publications

References 57 publications

Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Natural history of prostatic lesions on serial multiparametric magnetic resonance imaging

Can MRI/TRUS fusion targeted biopsy replace saturation prostate biopsy in the re-evaluation of men in active surveillance?

Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy

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