Value of 3‐Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance

Pessôa, Rodrigo; Viana, Públio César Cavalcante; Mattedi, Rômulo Loss; Guglielmetti, Giuliano; Cordeiro, Maurício; Coelho, Rafael F.; Nahas, William Carlos; Srougi, Miguel

doi:10.1111/bju.13624

Cited by 36 publications

(30 citation statements)

References 26 publications

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“…An initial 3502 studies underwent title and abstract screening, of which 127 studies were retrieved for full‐text review. In all, 31 studies reporting on 9480 patients (4296 with prostate cancer) met the inclusion criteria for meta‐analysis; 25 studies reported on mpMRI DTA (7000 patients, 2954 with prostate cancer), 12 studies reported on bpMRI DTA (2716 patients, 1477 with prostate cancer), and six studies directly compared mpMRI and bpMRI (2047 patients, 1063 with prostate cancer). Table provides a summary of the included studies [22,34––63], while Table provides a risk of bias summary of the included studies [22,34––63].…”

Section: Resultsmentioning

confidence: 99%

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

Alabousi¹,

Salameh

Gusenbauer

et al. 2019

BJU International

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Objective To perform a diagnostic test accuracy (DTA) systematic review and meta‐analysis comparing multiparametric (diffusion‐weighted imaging [DWI], T2‐weighted imaging [T2WI], and dynamic contrast‐enhanced [DCE] imaging) magnetic resonance imaging (mpMRI) and biparametric (DWI and T2WI) MRI (bpMRI) in detecting prostate cancer in treatment‐naïve patients. Methods The Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica dataBASE (EMBASE) were searched to identify relevant studies published after 1 January 2012. Articles underwent title, abstract, and full‐text screening. Inclusion criteria consisted of patients with suspected prostate cancer, bpMRI and/or mpMRI as the index test(s), histopathology as the reference standard, and a DTA outcome measure. Methodological and DTA data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)‐2 tool. DTA metrics were pooled using bivariate random‐effects meta‐analysis. Subgroup analysis was conducted to assess for heterogeneity. Results From an initial 3502 studies, 31 studies reporting on 9480 patients (4296 with prostate cancer) met the inclusion criteria for the meta‐analysis; 25 studies reported on mpMRI (7000 patients, 2954 with prostate cancer) and 12 studies reported on bpMRI DTA (2716 patients, 1477 with prostate cancer). Pooled summary statistics demonstrated no significant difference for sensitivity (mpMRI: 86%, 95% confidence interval [CI] 81–90; bpMRI: 90%, 95% CI 83–94) or specificity (mpMRI: 73%, 95% CI 64–81; bpMRI: 70%, 95% CI 42–83). The summary receiver operating characteristic curves were comparable for mpMRI (0.87) and bpMRI (0.90). Conclusions No significant difference in DTA was found between mpMRI and bpMRI in diagnosing prostate cancer in treatment‐naïve patients. Study heterogeneity warrants cautious interpretation of the results. With replication of our findings in dedicated validation studies, bpMRI may serve as a faster, cheaper, gadolinium‐free alternative to mpMRI.

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Section: Resultsmentioning

confidence: 99%

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

Alabousi¹,

Salameh

Gusenbauer

et al. 2019

BJU International

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“…This is not surprising considering reports showing that a standard prostate biopsy only samples approximately 1% of prostate tissue [14–16]. Studies have also shown that a clinical workup strategy, which includes prostate magnetic resonance imaging (MRI), aids the prediction of the results of confirmatory biopsy findings, however the results published so far demonstrate wide space for improvement in the use of MRI for this purpose [7; 17–20]. …”

Section: Introductionmentioning

confidence: 99%

The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer

et al. 2017

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Purpose To assess the performance of the updated Prostate Imaging Reporting and Data System (PI-RADSv2) and the Apparent Diffusion Coefficient (ADC) for predicting confirmatory biopsy results in patients considered for active surveillance of prostate cancer (PCA). Methods IRB-approved, retrospective study of 371-consecutive men with clinically low-risk PCA (initial biopsy Gleason score≤6, prostate-specific-antigen<10ng/ml, clinical stage≤T2a) who underwent 3T-prostate MRI before confirmatory biopsy. Two independent radiologists recorded the PI-RADSv2 scores and measured the corresponding ADC values in each patient. A composite score was generated to assess the performance of combining PI-RADSv2+ADC. Results PCA was upgraded on confirmatory biopsy in 107/371 (29%) patients. Inter-reader agreement was substantial (PI-RADSv2: k=0.73; 95%CI [0.66–0.80]; ADC: r=0.74; 95%CI [0.69–0.79]). Accuracies, sensitivities, specificities, positive, negative predicted values of PI-RADSv2 were 85%, 89%, 83%, 68%, 95% and 78%, 82%, 76%, 58%, 91% for ADC. PI-RADSv2 accuracy was significantly higher than that of ADC for predicting biopsy upgrade (p=0.014). The combined PI-RADSv2+ADC composite score did not perform better than PI-RADSv2 alone. Obviating biopsy in patients with PI-RADSv2 score ≤3 would have missed Gleason Score upgrade in 12/232 (5%) of patients. Conclusion PI-RADSv2 was superior to ADC measurements for predicting PCA upgrading on confirmatory biopsy.

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“…Different authors previously confirmed that PI-RADS score is an independent predictor of csPCa in AS candidates [14][15][16]. PI-RADS score provides additional information to existing scoring systems of PCa (i.e., both Epstein et al [17], D'Amico [18] and Cancer of the Prostate Risk Assessment: CAPRA [19]), and improves the assignment of patients to different treatments: AS vs. AT [15].…”

Section: Discussionmentioning

confidence: 91%

“…Targeted biopsies (tBx) have emerged as a useful tool to reduce standard biopsy misclassification rate of csPCa during AS [14,21,22]. Pessoa et al [14] reported a reclassification rate on tBx of 74.5 and 100%, in patients with PI-RADS score 4 and 5 lesions followed with AS.…”

Section: Discussionmentioning

confidence: 99%

“…Pessoa et al [14] reported a reclassification rate on tBx of 74.5 and 100%, in patients with PI-RADS score 4 and 5 lesions followed with AS. Analyzing our cohort, we believe that patients with PI-RADS scores 3 and 4 (EPE 0) could benefit from a tBx, so those patients with PI-RADS 3 who have csPCa should be selected and too many patients with PI-RADS score 4 with non-csPCa should not be excluded.…”

Section: Discussionmentioning

confidence: 99%

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Multiparametric Magnetic-Resonance to Confirm Eligibility to an Active Surveillance Program for Low-Risk Prostate Cancer: Intermediate Time Results of a Third Referral High Volume Centre Active Surveillance Protocol

et al. 2018

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Background: To evaluate the role of confirmatory multiparametric magnetic resonance imaging (mpMRI) of the prostate at the time of Active Surveillance (AS) enrollment to reduce disease misclassification. Materials: From 2012 to 2016, 383 patients with low-risk disease respecting Prostate Cancer Research International AS criteria underwent confirmatory 1.5-T mpMRI. AS was proposed to patients with Prostate Imaging and Report and Data System (PI-RADS) score ≤3 and no extraprostatic extension (EPE), whereas patients with PI-RADS score ≥4 and/or EPE were treated actively. Kaplan-Meier analyses quantified progression-free survival (PFS) in patients enrolled in the AS program. Logistic regression analyses tested the association between confirmatory mpMRI and clinically significant prostate cancer (csPCa) at radical prostatectomy (RP). Diagnostic performance of mpMRI was calculated in patients submitted to immediate RP. Results: PFS rate was 99, 90 and 86% at 1, 2 and 3 years respectively. At multivariable analysis, PI-RADS 3, PI-RADS 4, PI-RADS 5 and EPE increased the probability of having csPCa at immediate RP (PI-RADS 3 [OR] 1.2, p = 0.26; PI-RADS 4 [OR] 5.1, p = 0.02; PI-RADS 5 [OR] 6.7; p = 0.009; EPE [OR] 11.8, p < 0.001). Confirmatory mpMRI showed sensibility, specificity, positive predictive value and negative predictive value of 85, 55, 68 and 76% respectively. Conclusions: MpMRI at the time of AS enrollment reduces the misclassification rate of csPCa. We suggest to perform target biopsies in patients with PI-RADS score 3 and 4 lesions.

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Value of 3‐Tesla multiparametric magnetic resonance imaging and targeted biopsy for improved risk stratification in patients considered for active surveillance

Cited by 36 publications

References 26 publications

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment‐naïve patients: a diagnostic test accuracy systematic review and meta‐analysis

The performance of PI-RADSv2 and quantitative apparent diffusion coefficient for predicting confirmatory prostate biopsy findings in patients considered for active surveillance of prostate cancer

Multiparametric Magnetic-Resonance to Confirm Eligibility to an Active Surveillance Program for Low-Risk Prostate Cancer: Intermediate Time Results of a Third Referral High Volume Centre Active Surveillance Protocol

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