Can MRI Help Inform Which Men With a History of Multifocal High-Grade Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation Remain at an Elevated Risk for Clinically Significant Prostate Cancer?

Abstract

Purpose: We investigated the association of MRI findings in men with a previous diagnosis of atypical small acinar proliferation (ASAP) or multifocal high-grade intraepithelial neoplasia (HGPIN) with pathologic findings on repeat biopsy. Materials and Methods: We retrospectively reviewed patients with ASAP/ multifocal HGPIN undergoing a repeat biopsy in the Michigan Urological Surgery Improvement Collaborative registry. We included men with and without an MRI after the index biopsy demonstrating ASAP/multifocal HGPIN but before the repeat biopsy. Men with an MRI prior to the index biopsy were excluded. We compared the proportion of men with GG2 CaP (Grade Group 2 prostate cancer) on repeat biopsy among the following groups with the c 2 test: no MRI, PIRADS (Prostate ImagingeReporting and Data System) 4, and PIRADS 3. Multivariable models were used to estimate the adjusted association between MRI findings and GG2 CaP on repeat biopsy. Results: Among the 207 men with a previous diagnosis of ASAP/multifocal HGPIN that underwent a repeat biopsy, men with a PIRADS 4 lesion had a higher proportion of GG2 CaP (56%) compared with men without an MRI (12%, P < .001). A lower proportion of men with PIRADS 3 lesions had GG2 CaP (3.0%) compared with men without an MRI (12%, P [ .13). In the adjusted model, men with a PIRADS 4 to 5 lesion had higher odds (OR: 11.4, P < .001) of GG2 CaP on repeat biopsy. Conclusions: MRI is a valuable diagnostic tool to triage which men with a history of ASAP or multifocal HGPIN on initial biopsy should undergo or avoid repeat biopsy without missing clinically significant CaP.

Editorial Comment

“…This study by Sessine et al is significant because it provides valuable insights into how the use of MRI may be beneficial for risk stratification in this patient population. 1 The authors examined outcomes in prostate biopsy patients within MUSIC (the Michigan Urological Surgery Improvement Collaborative). By examining outcomes retrospectively from 207 men who had repeat biopsy with either multifocal HGPIN or ASAP on the initial biopsy, the authors were able to describe differences in outcomes between patients who happen to get an MRI prior to their second biopsy vs those who did not.…”