Stefan Carlsson1,2, Ola Bratt3, Dushanka Kristiansson4, Fredrik Jäderling2,5. 1. Urology Department, Karolinska University Hospital, Solna, Sweden. 2. Department of Molecular Medicine and Surgery (MMKa), Karolinska Institute, Stockholm, Sweden. 3. Department of Urology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. Farsta Urology Clinic, Stockholm, Sweden. 5. Radiology Department, Karolinska University Hospital, Solna, Sweden.
Abstract
OBJECTIVE: To assess the value of a first MRI examination and image-fusion-guided biopsies in men with low-risk prostate cancer who have been on active surveillance (AS) for several years with no signs of progression. PATIENTS AND METHODS: All 45 participants from two centers who had not previously had an MRI were included. They had been on AS for T1c Gleason score 6 prostate cancer for 2.6 to 6.7 years and had 2 to 5 sets of systematic biopsies with a total of 1640 cores. All underwent a bi-parametric MRI, PI-RADS ≥ 3 lesions were targeted with image-fusion-guided biopsies. Primary outcome measure: detection of Gleason score ≥7 cancer. RESULTS: Twenty-five of the 45 men (56%) had a total of 30 suspicious MRI lesions. The lesion with the highest score was a PI-RADS 3 in 18, a PI-RADS 4 in 5 and PI-RADS 5 in 3 men. Targeted biopsies from the 30 lesions detected Gleason score 7 cancer in 6 men. Of these six cancers, four were located in the apical and one in the anterior/apical part of the prostate. A Gleason score 7 cancer was detected in 3 of 5 men with PSA density >0.15 ng/ml/cm3. CONCLUSIONS: Even after several years of AS with stable PSA values and many sets of systematic biopsies, a first MRI and targeted biopsies lead to the detection of Gleason score 7 (ISUP 2 and ISUP 3) cancer in a significant proportion of men, particularly among those with a high PSA density.
OBJECTIVE: To assess the value of a first MRI examination and image-fusion-guided biopsies in men with low-risk prostate cancer who have been on active surveillance (AS) for several years with no signs of progression. PATIENTS AND METHODS: All 45 participants from two centers who had not previously had an MRI were included. They had been on AS for T1c Gleason score 6 prostate cancer for 2.6 to 6.7 years and had 2 to 5 sets of systematic biopsies with a total of 1640 cores. All underwent a bi-parametric MRI, PI-RADS ≥ 3 lesions were targeted with image-fusion-guided biopsies. Primary outcome measure: detection of Gleason score ≥7 cancer. RESULTS: Twenty-five of the 45 men (56%) had a total of 30 suspicious MRI lesions. The lesion with the highest score was a PI-RADS 3 in 18, a PI-RADS 4 in 5 and PI-RADS 5 in 3 men. Targeted biopsies from the 30 lesions detected Gleason score 7 cancer in 6 men. Of these six cancers, four were located in the apical and one in the anterior/apical part of the prostate. A Gleason score 7 cancer was detected in 3 of 5 men with PSA density >0.15 ng/ml/cm3. CONCLUSIONS: Even after several years of AS with stable PSA values and many sets of systematic biopsies, a first MRI and targeted biopsies lead to the detection of Gleason score 7 (ISUP 2 and ISUP 3) cancer in a significant proportion of men, particularly among those with a high PSA density.
Entities:
Keywords:
MRI fusion biopsy; Prostate cancer; active surveillance
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