Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

Abstract

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imagingreporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

Does Adding Standard Systematic Biopsy to Targeted Prostate Biopsy in PI-RADS 3 to 5 Lesions Enhance the Detection of Clinically Significant Prostate Cancer? Should All Patients with PI-RADS 3 Undergo Targeted Biopsy?

“…What our results primarily suggest is that the best scenario in which to add the standard biopsy is likely in patients under active surveillance, as this is where a greater increase in csPCa detection can be achieved, with no additional cost of diagnosing non-csPCa (as this will have already been diagnosed) [25,26]. A recent review and meta-analysis by Baccaglini et al showed similar positive predictive values for MRI-targeted biopsies alone vs. a combination of both targeted and standard biopsies in the context of active surveillance for patients with low-risk PCa.…”

The role of multiparametric magnetic resonance in active surveillance of a low‐risk prostate cancer cohort from clinical practice

“…From 2015 onward, we introduced the mpMRI before confirmatory (around 6 months after the diagnosis) and follow‐up biopsies. Based on the PIRADS category, we carried out systematic and/or fusion‐targeted biopsy as previously described 10 . Strict adherence to the protocol was neither analyzed nor required for this study.…”

“…The advent of multiparametric magnetic resonance imaging (mpMRI), with its high negative predictive value (NPV) and the performance of targeted biopsies versus systematic biopsy, has been shown to improve the detection rate of significant prostate cancer (SigPCa) 6,8 . Therefore, its use is currently recommended at least before the confirmation/reclassification biopsy required to enroll in an AS program, which improves the risk stratification of PCa and the selection of patients included in the program 9,10 . In this regard, Hamoen et al 11 concluded that a negative mpMRI within first year of AS program inclusion is the only predictor of a lower probability of reclassification during follow‐up.…”

How to Clearly and Accurately Report Odds Ratio and Hazard Ratio in Diagnostic Research Studies?

“…When 34 original research studies reporting OR published in the Korean Journal of Radiology in 2020–2021 [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 ] were evaluated against a rigorous standard (i.e., complete transparency in reporting), 91.2% (31/34) clearly mentioned how they defined the odds, 62.1% (18/29) unmistakably described the reference category for OR calculation for categorical variables, and 42.9% (9/21) specified the one-unit amount for OR for continuous variables. Therefore, there is room for improvement in reporting.…”

“…When 28 original research studies reporting HR published in the Korean Journal of Radiology in 2020–2021 [ 11 15 32 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 ] were evaluated against a rigorous standard, 96.4% (27/28) explicitly defined the events for HR, 48.1% (13/27) unmistakably described the reference category for HR calculation for categorical variables, and only 50% (10/20) clearly described the one-unit amount for HR for continuous variables. Therefore, further improvements are required.…”