Changes in Magnetic Resonance Imaging Using the Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation Criteria to Detect Prostate Cancer Progression for Men on Active Surveillance.

Abstract

BACKGROUND:

The ability of serial magnetic resonance imaging (MRI) to capture pathologic progression during active surveillance (AS) remains in question.

OBJECTIVE:

To determine whether changes in MRI are associated with pathologic progression for patients on AS.

DESIGN, SETTING, AND PARTICIPANTS:

From July 2007 through January 2020, we identified all patients evaluated for AS at our institution. Following confirmatory biopsy, a total of 391 patients who underwent surveillance MRI and biopsy at least once were identified (median follow-up of 35.6 mo, interquartile range 19.7-60.6).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

All MRI intervals were scored using the "Prostate Cancer Radiologic Estimation of Change in Sequential Evaluation" (PRECISE) criteria, with PRECISE scores =4 considered a positive change in MRI. A generalized estimating equation-based logistic regression analysis was conducted for all intervals with a PRECISE score of <4 to determine the predictors of Gleason grade group (GG) progression despite stable MRI.

RESULTS AND LIMITATIONS:

A total of 621 MRI intervals were scored by PRECISE and validated by biopsy. The negative predictive value of stable MRI (PRECISE score <4) was greatest for detecting GG1 to?=?GG3 disease (0.94 [0.91-0.97]). If 2-yr surveillance biopsy were performed exclusively for a positive change in MRI, 3.7% (4/109) of avoided biopsies would have resulted in missed progression from GG1 to?=?GG3 disease. Prostate-specific antigen (PSA) density (odds ratio 1.95 [1.17-3.25], p?=? 0.01) was a risk factor for progression from GG1 to =GG3 disease despite stable MRI.

CONCLUSIONS:

In patients with GG1 disease and stable MRI (PRECISE score <4) on surveillance, grade progression to?=?GG3 disease is not common. In patients with grade progression detected on biopsy despite stable MRI, elevated PSA density appeared to be a risk factor for progression to?=?GG3 disease.

PATIENT SUMMARY:

For patients with low-risk prostate cancer on active surveillance, the risk of progressing to grade group 3 disease is low with a stable magnetic resonance image (MRI) after 2?yr. Having higher prostate-specific antigen density increases the risk of progression, despite having a stable MRI.

• Authors: Luke P O'Connor, Alex Z Wang, Nitin K Yerram, Lori Long, Michael Ahdoot, Amir H Lebastchi, Sandeep Gurram, Johnathan Zeng, Stephanie A Harmon, Sherif Mehralivand, Maria J Merino, Howard L Parnes, Peter L Choyke, Joanna H Shih, Bradford J Wood, Baris Turkbey, Peter A Pinto
• Journal: European urology oncology (Eur Urol Oncol) Vol. 4 Issue 2 Pg. 227-234 (04 2021) ISSN: 2588-9311 [Electronic] Netherlands
• PMID: 33867045 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020. Published by Elsevier B.V.

Topics

• Humans
• Magnetic Resonance Imaging
• Male
• Neoplasm Grading
• Prostatic Neoplasms (diagnostic imaging)
• Watchful Waiting