BACKGROUND: Outcomes of serial multiparametric magnetic resonance imaging (mpMRI) and subsequent biopsy in monitoring prostate cancer (PCa) in men on active surveillance (AS) have not been defined clearly. OBJECTIVE: To determine whether changes in serial mpMRI can predict pathological upgrade among men with grade group (GG) 1 PCa managed with AS. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of men with GG1 on AS with at least two consecutive mpMRI examinations during 2012-2018 who underwent mpMRI/ultrasound fusion or systematic biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Progression on serial mpMRI was evaluated as a predictor of pathological upgrading to GG≥2 on a follow-up biopsy using clinical, pathological, and imaging factors in binary logistic regression. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were determined. RESULTS AND LIMITATIONS: Of 122 patients, 29 men (23.8%) experienced pathological upgrade on the follow-up biopsy. Progression on mpMRI was not associated with pathological upgrade. The sensitivity, specificity, PPV, and NPV of mpMRI progression for predicting pathological upgrade were 41.3%, 54.8%, 22.2%, and 75%, respectively. Age (odds ratio [OR] 1.17, p=0.006), Prostate Imaging Reporting and Data System (PI-RADS) score on initial mpMRI (4-5 vs ≤3, OR 7.48, p=0.01), number of positive systematic cores (OR 1.84, p=0.03), number of positive targeted cores (OR 0.44, p=0.04), and maximum percent of targeted core tumor involvement (OR 1.04, p=0.01) were significantly associated with pathological upgrade. CONCLUSIONS: We did not observe an association between mpMRI progression and pathological upgrade; however, a PI-RADS score of 4-5 on initial mpMRI was predictive of subsequent pathological progression. The continued use of systematic and fusion biopsies appears necessary due to risks of reclassification over time. PATIENT SUMMARY: Progression on serial multiparametric magnetic resonance imaging during active surveillance (AS) is not associated with progression on the follow-up biopsy. Both systematic and fusion biopsies are necessary to sufficiently capture progression during AS.
BACKGROUND: Outcomes of serial multiparametric magnetic resonance imaging (mpMRI) and subsequent biopsy in monitoring prostate cancer (PCa) in men on active surveillance (AS) have not been defined clearly. OBJECTIVE: To determine whether changes in serial mpMRI can predict pathological upgrade among men with grade group (GG) 1 PCa managed with AS. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of men with GG1 on AS with at least two consecutive mpMRI examinations during 2012-2018 who underwent mpMRI/ultrasound fusion or systematic biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Progression on serial mpMRI was evaluated as a predictor of pathological upgrading to GG≥2 on a follow-up biopsy using clinical, pathological, and imaging factors in binary logistic regression. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were determined. RESULTS AND LIMITATIONS: Of 122 patients, 29 men (23.8%) experienced pathological upgrade on the follow-up biopsy. Progression on mpMRI was not associated with pathological upgrade. The sensitivity, specificity, PPV, and NPV of mpMRI progression for predicting pathological upgrade were 41.3%, 54.8%, 22.2%, and 75%, respectively. Age (odds ratio [OR] 1.17, p=0.006), Prostate Imaging Reporting and Data System (PI-RADS) score on initial mpMRI (4-5 vs ≤3, OR 7.48, p=0.01), number of positive systematic cores (OR 1.84, p=0.03), number of positive targeted cores (OR 0.44, p=0.04), and maximum percent of targeted core tumor involvement (OR 1.04, p=0.01) were significantly associated with pathological upgrade. CONCLUSIONS: We did not observe an association between mpMRI progression and pathological upgrade; however, a PI-RADS score of 4-5 on initial mpMRI was predictive of subsequent pathological progression. The continued use of systematic and fusion biopsies appears necessary due to risks of reclassification over time. PATIENT SUMMARY: Progression on serial multiparametric magnetic resonance imaging during active surveillance (AS) is not associated with progression on the follow-up biopsy. Both systematic and fusion biopsies are necessary to sufficiently capture progression during AS.
Authors: Amanda Khoo; Lydia Y Liu; Julius O Nyalwidhe; O John Semmes; Danny Vesprini; Michelle R Downes; Paul C Boutros; Stanley K Liu; Thomas Kislinger Journal: Nat Rev Urol Date: 2021-08-27 Impact factor: 14.432
Authors: Jonathan Olivier; Weiyu Li; Daan Nieboer; Jozien Helleman; Monique Roobol; Vincent Gnanapragasam; Mark Frydenberg; Mikio Sugimoto; Peter Carroll; Todd M Morgan; Riccardo Valdagni; Jose Rubio-Briones; Grégoire Robert; Phillip Stricker; Andrew Hayen; Ivo Schoots; Masoom Haider; Caroline M Moore; Brian Denton; Arnauld Villers Journal: Eur Urol Open Sci Date: 2022-01-03
Authors: Benjamin H Press; Tashzna Jones; Olamide Olawoyin; Soum D Lokeshwar; Syed N Rahman; Ghazal Khajir; Daniel W Lin; Matthew R Cooperberg; Stacy Loeb; Burcu F Darst; Yingye Zheng; Ronald C Chen; John S Witte; Tyler M Seibert; William J Catalona; Michael S Leapman; Preston C Sprenkle Journal: Eur Urol Open Sci Date: 2022-02-11
Authors: Kamyar Ghabili; Nathan Paulson; Jamil S Syed; Cayce B Nawaf; Ghazal Khajir; Darryl T Martin; John Onofrey; Michael S Leapman; Angelique Levi; Jeffrey C Weinreb; Peter A Humphrey; Preston C Sprenkle Journal: Case Rep Urol Date: 2021-03-17
Authors: Sarah Hagmann; Venkat Ramakrishnan; Alexander Tamalunas; Marc Hofmann; Moritz Vandenhirtz; Silvan Vollmer; Jsmea Hug; Philipp Niggli; Antonio Nocito; Rahel A Kubik-Huch; Kurt Lehmann; Lukas John Hefermehl Journal: Cancers (Basel) Date: 2022-01-12 Impact factor: 6.639