The Use of Multiparametric Magnetic Resonance Imaging for Follow-up of Patients Included in Active Surveillance Protocol. Can PSA Density Discriminate Patients at Different Risk of Reclassification?

Roscigno, Marco; Stabile, Armando; Lughezzani, Giovanni; Pepe, Pietro; Galosi, Andrea Benedetto; Naselli, Angelo; Naspro, Richard; Nicolaï, M.; Croce, Giovanni La; Aljoulani, Muhannad; Perugini, Giovanna; Guazzoni, Giorgio; Montorsi, Francesco; Balzarini, Luca; Sironi, Sandro; Pozzo, L. Da

doi:10.1016/j.clgc.2020.04.006

Cited by 28 publications

(21 citation statements)

References 19 publications

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“…Our findings formally describe the association of PSAD with clinical outcome in imaging-led AS and support the use of dynamic risk estimation for individualising the timing of follow-up tests or radical treatment. In addition, our results corroborate those of other authors who report higher rates of upgrading in men with MRI-visible Gleason 3 + 3 disease and high PSAD at baseline [7,8]. The limitations inherent to our cohort have been described, principally its retrospective, single-centre nature and the avoidance of scheduled biopsies in favour of a personalised, risk-adjusted biopsy approach.…”

Section: Discussionsupporting

confidence: 86%

Mapping PSA density to outcome of MRI-based active surveillance for prostate cancer through joint longitudinal-survival models

Stavrinides

Παπαγεωργίου

Danks

et al. 2021

Prostate Cancer Prostatic Dis

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Section: Discussionsupporting

confidence: 86%

Mapping PSA density to outcome of MRI-based active surveillance for prostate cancer through joint longitudinal-survival models

Stavrinides

Παπαγεωργίου

Danks

et al. 2021

Prostate Cancer Prostatic Dis

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“…In conclusion, PI-RADS 3 lesions exhibited aggressive features in a not negligible proportion of cases but a quality control of mpMRI by experienced radiologists improve the accuracy of the procedure; a second opinion is mandatory especially in men enrolled in AS protocols in whom clinical parameters (5,24,25) and mpMRI (26)(27)(28) are recommended to reduce the number of scheduled repeated prostate biopsies.…”

Section: Discussionmentioning

confidence: 94%

mpMRI PI-RADS score 3 lesions diagnosed by reference vs affiliated radiological centers: Our experience in 950 cases

Pepe

Candiano

Pepe

et al. 2021

Arch Ital Urol Androl

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Introduction: The detection rate for clinically significant prostate cancer (csPCa) in men with mpMRI PI-RADS score 3 diagnosed by affiliated radiology centers vs radiological reference center was evaluated. Materials and methods: From January 2017 to December 2020, 950 men (median age 64 years) underwent mpMRI for abnormal PSA values (median 6.3 ng/ml). Among the 950 patients who underwent mpMRI 500 were evaluated by a reference center and 450 by outpatient radiological affiliated centers. All the mpMRI index lesions characterized by a PI-RADS 3 underwent targeted cores combined with extended prostate biopsy. Two radiologists of the radiological reference center revised all the mpMRI lesions 3. Results: Overall, 361/950 (38%) patients had a mpMRI lesion PI-RADS score 3: 120/500 cases (24%) vs 241/450 cases (53.5%) were diagnosed by reference vs affiliated radiological centers. The detection rate for cT1c csPCa was equal to 26.7% (35/120 cases) vs 16.6% (40/241 cases) in men with PI-RADS 3 lesions diagnosed in the reference vs the affiliated radiological centers (p < 0.05). Among the 241 PI-RADS score 3 lesions diagnosed by affiliated radiological centers 86/241 (35.7%) and 36/241 (15%) were downgraded (PI-RADS scores < 3) and upgraded (PI-RADS score 4) by the dedicated radiologists of the reference center. Conclusions: In our series, about 35% and 15% of PI-RADS score 3 lesions diagnosed by affiliated radiological centers were downgraded and upgraded when revised by experencied radiologists, therefore a second opinion is mandatory especially in men enrolled in active surveillance protocols in whom mpMRI is recommended to reduce the number of scheduled repeated prostate biopsies.

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“…In order to reduce side effects of systematic biopsy, several non-invasive strategies has been proposed (22). The PSA-density, as supported by Roscigno et al (23), was used with a cut-off ≥ 0.20 ng/mL to improve the predictive accuracy of mpMRI results for reclassification of patients in AS, whereas a PSAD value < 0.10 ng/mL identifies a lower risk of harboring clinically significant cancer. Nowadays, the combination of target and SB represents the standard for patients on AS; our study strengthens this recommendation, showing that additional random cores improved the overall CDR of 28% and clinically significant CDR of 31%.…”

Section: Discussionmentioning

confidence: 99%

MRI/US fusion prostate biopsy in men on active surveillance: Our experience

Lacetera

Antezza

Papaveri

et al. 2021

Arch Ital Urol Androl

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Aim: The upgrading or staging in men with prostate cancer (PCA) undergoing active surveillance (AS), defined as Gleason score (GS) ≥ 3+4 or more than 2 area with cancer, was investigated in our experience using the software-based fusion biopsy (FB). Methods: We selected from our database, composed of 620 biopsies, only men on AS according to criteria of John Hopkins Protocol (T1c, < 3 positive cores, GS = 3+3 = 6). Monitoring consisted of PSA measurement every 3 months, a clinical examination every 6 months, confirmatory FB within 6 months and then annual FB in all men. The suspicious MRI lesions were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) classification version 2. FB were performed with a transrectal elastic free-hand fusion platform. The overall and clinically significant cancer detection rate was reported. Secondary, the diagnostic role of systematic biopsies was evaluated. Results: We selected 56 patients on AS with mean age 67.4 years, mean PSA 6.7 ng/ml and at least one follow-up MRI-US fusion biopsy (10 had 2 or 3 follow-up biopsies). Lesions detected by MRI were: PIRADS-2 in 5, PIRADS-3 in 28, PIRADS-4 in 18 pts and PIRADS-5 in 5 patients. In each MRI lesion, FB with 2.1 ± 1.1 cores were taken with a mean total cores of 13 ± 2.4 including the systematic cores. The overall cancer detection rate was 71% (40/56): 62% (25/40) in target core and 28% (15/40) in systematic core. The overall significant cancer detection rate was 46% (26/56): 69% (18/26) in target vs 31% (8/26) in random cores. Conclusions: The incidence of clinical significant cancer was 46% in men starting active surveillance, but it was more than doubled using MRI/US Target Biopsy 69% (18/26) rather than random cores (31%, 8/26). However, 1/3 of disease upgrades would have been missed if only the targeted biopsies were performed. Based on our experience, MRI/US fusion target biopsy must be associated to systematic biopsies to improve detection of significant cancer, reducing the risks of misclassification.

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The Use of Multiparametric Magnetic Resonance Imaging for Follow-up of Patients Included in Active Surveillance Protocol. Can PSA Density Discriminate Patients at Different Risk of Reclassification?

Cited by 28 publications

References 19 publications

Mapping PSA density to outcome of MRI-based active surveillance for prostate cancer through joint longitudinal-survival models

Mapping PSA density to outcome of MRI-based active surveillance for prostate cancer through joint longitudinal-survival models

mpMRI PI-RADS score 3 lesions diagnosed by reference vs affiliated radiological centers: Our experience in 950 cases

MRI/US fusion prostate biopsy in men on active surveillance: Our experience

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