The role of multiparametric magnetic resonance in active surveillance of a low‐risk prostate cancer cohort from clinical practice

Abstract

Introduction: Active surveillance (AS) is considered a suitable management practice for those patients with low-risk prostate cancer (PCa). At present, however, the role of multiparametric magnetic resonance imaging (mpMRI) in AS protocols has not yet been clearly established.Outcomes: To determine the role of mpMRI and its ability to detect significant prostate cancer (SigPCa) in PCa patients enrolled in AS protocols. Materials and Methods: There were 229 patients enrolled in an AS protocol between 2011 and 2020 at Reina Sofía University Hospital. MRI interpretation was based on PIRADS v.1 or v.2/2.1 classification. Demographics, clinical, and analytical data were collected and analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for mpMRI in different scenarios. We defined SigPCa and reclassification/progression as a Gleason score (GS) ≥ 3 + 4, a clinical stage ≥T2b, or an increase in PCa volume. Kaplan-Meier and log-rank tests were used to estimate progression-free survival time. Results: Median age was 69.02 (±7.73) at diagnosis, with a 0.15 (±0.08) PSA density (PSAD). Eighty-six patients were reclassified after confirmatory biopsy, with a suspicious mpMRI an indication for a clear reclassification and risk-predictor factor in disease progression (p < 0.05). During follow-up, 46 patients were changed from AS to active treatment mainly due to disease progression. Ninety patients underwent ≥2mpMRI during follow-up, with a median follow-up of 29 (15-49) months. Thirty-four patients had a baseline suspicious mpMRI (at diagnostic or confirmatory biopsy): 14 patients with a PIRADS 3 and 20 patients with ≥PIRADS 4.From 14 patients with a PIRADS 3 baseline mpMRI, 29% progressed radiologically, with a 50% progression rate versus 10% (1/10 patients) for those with similar or

Uso da ressonância magnética multiparamétrica na vigilância ativa do câncer de próstata: Uma revisão integrativa

“…Os demais estudos relatam a importância da RMmp no seguimento da VA, sendo que quando em conjunto com outras variáveis como densidade de PSA e classificação PI-RADS no momento do diagnóstico inicial, os pacientes poderiam ter indicação de biópsia baseada apenas nas alterações dos exames, visto que a RMmp apresentou um alto valor preditivo negativo (VPN). O VPN foi avaliado em 8 estudos dessa revisão, sendo que variou entre 75% e 100%, a exemplo disso, Castillo et al (2023) encontraram um VPN de 91%, por ser elevado, implica-se que o uso da RMmp pode reduzir a necessidade de biópsia para monitorar os pacientes em VA, pois a RMmp negativa indica baixo risco para progressão da doença.…”

Multiparametric magnetic resonance imaging in the active surveillance of prostate cancer: protocol, risk stratification, and surveillance

“…To achieve a balance between avoiding unnecessary treatment and adopting a more aggressive approach, active surveillance (AS) has gained increasing importance in the management of prostate cancer (PCa) [6]. Multiparametric magnetic resonance imaging (mp-MRI) provides a more precise assess-ment of tumor size and extent, improves risk stratification, and aids in treatment allocation, and is recommended by several international guidelines for assessing the risk of PCa [7][8][9]. Concerns have arisen regarding how to define the boundaries of AS and active treatment safely, as well as the selection of appropriate procedures for conducting AS once initiated and the role of imaging markers in the AS of these patients.…”