Can MRI replace serial biopsies in men on active surveillance for prostate cancer?

Moore, Caroline M.; Petrides, Neophytos; Emberton, Mark

doi:10.1097/mou.0000000000000040

Cited by 29 publications

(21 citation statements)

References 32 publications

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“…7 Few studies to date have evaluated serial mpMRI findings in men with low risk PCa 8–12 and these questions remain largely unanswered. In this study we assessed whether changes in serial mpMRI can help predict the pathological progression of PCa in men on AS.…”

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confidence: 99%

Serial Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: Incremental Value

Felker

Natarajan

et al. 2016

Journal of Urology

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Purpose We assessed whether changes in serial multiparametric magnetic resonance imaging can help predict the pathological progression of prostate cancer in men on active surveillance. Materials and Methods A retrospective cohort study was conducted of 49 consecutive men with Gleason 6 prostate cancer who underwent multi-parametric magnetic resonance imaging at baseline and again more than 6 months later, each followed by a targeted prostate biopsy, between January 2011 and May 2015. We evaluated whether progression on multiparametric magnetic resonance imaging (an increase in index lesion suspicion score, increase in index lesion volume or decrease in index lesion apparent diffusion coefficient) could predict pathological progression (Gleason 3 + 4 or greater on subsequent biopsy, in systematic or targeted cores). Diagnostic performance of multiparametric magnetic resonance imaging was determined with and without clinical data using a binary logistic regression model. Results The mean interval between baseline and followup multiparametric magnetic resonance imaging was 28.3 months (range 11 to 43). Pathological progression occurred in 19 patients (39%). The sensitivity, specificity, positive predictive value and negative predictive value of multiparametric magnetic resonance imaging was 37%, 90%, 69% and 70%, respectively. Area under the receiver operating characteristic curve was 0.63. A logistic regression model using clinical information (maximum cancer core length greater than 3 mm on baseline biopsy or a prostate specific antigen density greater than 0.15 ng/ml2 at followup biopsy) had an AUC of 0.87 for predicting pathological progression. The addition of serial multiparametric magnetic resonance imaging data significantly improved the AUC to 0.91 (p = 0.044). Conclusions Serial multiparametric magnetic resonance imaging adds incremental value to prostate specific antigen density and baseline cancer core length for predicting Gleason 6 upgrading in men on active surveillance.

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confidence: 99%

Serial Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: Incremental Value

Felker

Natarajan

et al. 2016

Journal of Urology

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“…Other authors have also reported higher sensitivity for high-grade tumor and more reliable confirmation of low-risk disease using MRI and subsequent targeted biopsy (32,33). Indeed, improved risk stratification in the AS setting may be considered one of the primary applications of prostate MRI and targeted biopsy in clinical practice today (34,35). The greater accuracy of MRI-targeted biopsy for clinically significant cancer reduces uncertainty and anxiety associated with a low-risk biopsy result.…”

Section: Improved Risk Stratification and Treatment Selection Using Mrimentioning

confidence: 94%

Prostate MRI Can Reduce Overdiagnosis and Overtreatment of Prostate Cancer

Rosenkrantz¹,

Taneja²

2015

Academic Radiology

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“…1 Meanwhile, recent reports suggests that ADC maps of DWI sequences, when not concerning, provide a high negative predictive value to rule out occult higher grade disease. 20,21 This has led to enthusiasm to replace the confirmatory biopsy with a staging mpMRI. However, a recently published study from Memorial Sloan Kettering raises concerns with such an approach.…”

Section: Multi-parametric Magnetic Resonance Imagingmentioning

confidence: 99%

Advances in Prostate Cancer Magnetic Resonance Imaging and Positron Emission Tomography-Computed Tomography for Staging and Radiotherapy Treatment Planning

Moghanaki

Türkbey

Vapiwala

et al. 2017

Seminars in Radiation Oncology

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Conventional prostate cancer staging strategies have limited accuracy to define the location, grade, and burden of disease. Evaluations have historically relied upon prostate specific antigen levels, digital rectal examinations, random systematic biopsies, computed tomography, pelvic lymphadenectomy, and/or 99mTc-MDP bone scans. Today, risk-stratification tools incorporate these data in a weighted format to guide management. However, the limitations and potential consequences of their uncertainties are well-known. Inaccurate information may contribute to under-staging and under-treatment, or over-staging and over-treatment. Meanwhile, advances in multi-parametric MRI, whole body MRI, lymphotropic-nanoparticle MRI, and positron emission tomography are now available to improve the accuracy of risk stratification to facilitate more informed medical decisions. They also guide radiation oncologists to develop more accurate treatment plans. This review provides a primer to incorporate these advances into routine clinical workflow.

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Can MRI replace serial biopsies in men on active surveillance for prostate cancer?

Abstract: MRI is useful in the identification of men with higher-risk prostate cancer prior to commencement of a formal active surveillance programme. It is also of use in following up men on active surveillance, as a way to detect change in tumour over time.

Cited by 29 publications

References 32 publications

Serial Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: Incremental Value

Serial Magnetic Resonance Imaging in Active Surveillance of Prostate Cancer: Incremental Value

Prostate MRI Can Reduce Overdiagnosis and Overtreatment of Prostate Cancer

Advances in Prostate Cancer Magnetic Resonance Imaging and Positron Emission Tomography-Computed Tomography for Staging and Radiotherapy Treatment Planning

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