Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

Mamawala, Mufaddal; Meyer, Alexa; Landis, Patricia; Macura, Katarzyna J.; Epstein, Jonathan I.; Partin, Alan W.; Carter, Ballentine H.; Gorin, Michael A.

doi:10.1111/bju.15033

Cited by 20 publications

(17 citation statements)

References 34 publications

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“…We also note that in previous studies, lesions in patients with GG 1 PCa were reported to be largely invisible on mpMRI [ 16 17 18 ]. Therefore, although several studies have reported mpMRI to be useful for the selection of candidates appropriate for AS [ 19 20 ], mpMRI may, in fact, be reliable only for candidates with GG ≥2 lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Since the introduction of mpMRI for PCa, mpMRI and PI-RADS scoring have been used as screening criteria for AS [ 7 19 20 ]. Zhai et al [ 19 ] reported that the pooled estimates of PI-RADS scores of 4 or 5 predicted adverse pathologic features on examination of RP specimens among AS candidates, based on the PRIAS criteria, with a sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of 0.77, 0.63, 0.72, 0.68, and 0.77, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Kim et al [ 7 ] reported that multiple PI-RADS 5 lesions were strongly associated with GG 3 or pathologic T3 disease. Mamawala et al [ 20 ] reported 2- and 4-year upgrade-free survival rates of 93% and 83%, 74% and 59%, and 87% and 76%, respectively, for negative mpMRI, positive mpMRI (PI-RADS ≥3), and pre-mpMRI era, respectively (p<0.001). In a multivariable analysis, positive mpMRI findings (defined by a PI-RADS score ≥3) predicted a significantly higher rate of GG upgrading than did negative mpMRI findings with a hazard ratio for GG upgrading of 0.61 (p=0.030) for negative mpMRI findings compared with 1.96 (p<0.001) for positive mpMRI findings [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

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Purpose To evaluate the usefulness of multiparametric magnetic resonance imaging (mpMRI) to avoid misclassification of patients with clinically significant prostate cancer (PCa) into active surveillance (AS). Materials and Methods Patients with Gleason grade group (GG) 1 PCa on systematic biopsy who underwent mpMRI before radical prostatectomy (RP) were included. mpMRI and pathologic results were compared between the AS and NOT-AS candidates. Unfavorable disease was defined as the identification of T3-4 disease or GG upgrade in the RP specimen. We established an ideal cutoff Prostate Imaging Reporting and Data System (PI-RADS) score for predicting unfavorable disease, and analyzed the location of index lesions on mpMRI. Results PI-RADS scores were not significantly different between AS candidates (n=64) and NOT-AS candidates (n=136; p=0.629). Among 64 AS candidates, GG upgrading and unfavorable disease were diagnosed after RP in 24 (37.5%) and 25 (39.1%) patients, respectively. The rate of unfavorable disease was greater for patients with a PI-RADS score of 5 (83.3%) than in those with a score ≤4 (34.5%; p=0.030). Moreover, most PI-RADS 5 lesions in AS candidates were located in the anterior half of the prostate, with GG upgrading on targeted biopsy in 75.0% of cases. Conclusions Among the patients with GG 1 PCa, PI-RADS scores did not differ significantly between AS and NOT-AS candidates. Nonetheless, AS candidates with PI-RADS 5 lesions were diagnosed with unfavorable disease in >80% of RP specimens. Significant cancer located in the anterior half of the prostate including the transitional zone can be missed by systematic biopsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

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“…Risk calculators, such as the Canary Prostate Active Surveillance Study risk calculation 87 , the Johns Hopkins model 88 and the PRIAS model 89 have been developed in an effort to address this need. These AS risk calculators can selectively predict men at risk of progression and balance reclassification detection with the number of surveillance biopsies by incorporating the serial measurement of the monitoring tools into the prediction model (for example, patient age, prostate volume, PSA, time since diagnosis, number of previous biopsies and all previous biopsy results) [90][91][92][93][94] .…”

Section: Research Need Number 2 Develop Indicators To Better Stratifymentioning

confidence: 99%

The Movember Prostate Cancer Landscape Analysis: an assessment of unmet research needs

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Prostate cancer is the second most diagnosed solid-organ malignancy in men 1 , with >1.2 million new cases and 358,989 deaths reported worldwide in 2018 (ref. 2). Since 2005, the global men's health charity Movember has invested in a variety of very influential programmes in biomedical research, survivorship and clinical quality and has set ambitious organizational objectives to work with its global partners to halve the number of deaths from prostate cancer and to halve the number of men facing ongoing adverse effects from treatment by 2030. In order to transform these aspirations into reality, Movember needs to understand the gaps and opportunities in the field. Given that the last published analysis of the field was conducted by Tindall and Scardino 3 ~20 years ago, Movember's Global Scientific Committee (GSC) recommended that the Movember Biomedical Research Team commission a formal landscape analysis to assess the international prostate cancer research field in order to optimize future research investment and maximize biomedical research outcomes. The scope of this analysis was restricted to the role of Movember as a funder whose purpose is to positively change clinical practice in the prostate cancer biomedical research field for the benefit of men. In this Consensus Statement, we present the results and conclusions of Movember's prostate cancer global landscape analysis. Methods The Movember prostate cancer landscape analysis commenced in April 2017. A sequential research design was used, in which insights gathered from stakeholder

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“…Significant sampling error and morbidity associated with prostate biopsy complicates differentiation between aggressive and indolent disease so that post-radical prostatectomy (RP) upgrading and upstaging is common [5][6][7]. Recently, multi-parametric magnetic resonance imaging (mpMRI) showed improvements in risk stratification of men on AS and was recommended for enhancing enrolment and monitoring decision [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

No detrimental effect of a positive family history on postoperative upgrading and upstaging in men with low risk and favourable intermediate-risk prostate cancer: implications for active surveillance

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Purpose To assess whether a first-degree family history or a fatal family history of prostate cancer (PCa) are associated with postoperative upgrading and upstaging among men with low risk and favourable intermediate-risk (FIR) PCa and to provide guidance on clinical decision making for active surveillance (AS) in this patient population. Methods Participants in the German Familial Prostate Cancer database diagnosed from 1994 to 2019 with (1) low risk (clinical T1c–T2a, biopsy Gleason Grade Group (GGG) 1, PSA < 10 ng/ml), (2) Gleason 6 FIR (clinical T1c–T2a, GGG 1, PSA 10–20 ng/ml), and (3) Gleason 3 + 4 FIR (clinical T1c–T2a, GGG 2, PSA < 10 ng/ml) PCa who were subsequently treated with radical prostatectomy (RP) were analysed for upgrading, defined as postoperative GGG 3 tumour or upstaging, defined as pT3–pT4 or pN1 disease at RP. Logistic regression analysis was used to assess whether PCa family history was associated with postoperative upgrading or upstaging. Results Among 4091 men who underwent RP, mean age at surgery was 64.4 (SD 6.7) years, 24.7% reported a family history, and 3.4% a fatal family history. Neither family history nor fatal family history were associated with upgrading or upstaging at low risk, Gleason 6 FIR, and Gleason 3 + 4 FIR PCa patients. Conclusion Results from the current study indicated no detrimental effect of family history on postoperative upgrading or upstaging. Therefore, a positive family history or fatal family history of PCa in FIR PCa patients should not be a reason to refrain from AS in men otherwise suitable.

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Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

Cited by 20 publications

References 34 publications

Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

The Movember Prostate Cancer Landscape Analysis: an assessment of unmet research needs

No detrimental effect of a positive family history on postoperative upgrading and upstaging in men with low risk and favourable intermediate-risk prostate cancer: implications for active surveillance

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