THE ROLE OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN ACTIVE SURVEILLANCE OF PROSTATE CANCER
Authors:
Šárka Kudláčková 1; Milan Král 1; Daniela Kurfürstová 2; František Záťura 1; František Hruška 1; Igor Hartmann 1; Vladimír Študent 1
Authors‘ workplace:
Urologická klinika LF UP a FN Olomouc
1; Ústav klinické a molekulární patologie LF UP a FN Olomouc
2
Published in:
Ces Urol 2017; 21(3): 225-230
Category:
Original Articles
Overview
The aim of the study:
Evaluation of MRI biopsy results in active surveillance patients and evaluation of the benefit of MRI deployment in the AS protocol.
Methods:
Sixty-nine patients meeting the Epstein criteria were enrolled in active surveillance since 2009. 30 patients underwent multiparameteric magnetic resonance of the prostate (mp-MRI) during follow-up. The structured scoring system PI-RADS v.2 was used for evaluation. Targeted biopsy of the lesion described as PIRADS score 4 or score 5 was performed. The incidence of carcinoma and the consistency between the lesions described as PIRADS score 4 and PIRADS score 5 and the positivity of the core was evaluated. If the Epstein criteria were not met then radical treatment was implemented. For the continuation of AS we did not allow even a minimal presence of GS 3+4 or a higher number of positive cores than 2. The change in the strategy towards radical treatment and evaluation of final preparations after radical robotic prostatectomy (RARP) was evaluated. We evaluated the upgrading and upstaging as well as the overall prognostic assessment.
Results:
The average follow-up time was 3.37 (1–9) years. The mean age of the patient was 65.8 (55–74) years, the mean PSA was 6.08 (2.54–9.58) ng / ml, the mean prostate volume 59 (16–113) ml and an average density of 0.17 0.04–0.44). Carcinoma was confirmed by targeted biopsy in 19 patients (capture 63 %). The incidence of carcinoma in positive MRI with PIRADS 4 was 32 % and with PIRADS 5 76 %. 13 patients (43 %), based on the results of the targeted biopsy, terminated AS for non-compliance with AS protocol and proposed radical treatment (9 underwent RARP, 2 RARP in plan and 2 RT). Compared to the final results after RARP, upgrading occurred in 33 % of patients (3/9) and upstaging in 22 % of patients (2/9). In patients who underwent radical prostatectomy, favorable outcomes in 5 patients (55 %) and unfavorable outcomes in 4 patients (45 %) were achieved. All patients who underwent radical treatment are still in remission.
Conclusion:
Incidence of high risk cancer in targeted biopsies was 43 %. This caused the termination of active surveillance and undergoing of radical therapy. Mp-MRI can help identify aggressive disease during active surveillance and thus increase the safety of this strategy for patients. For the use of MRI during AS, it will be necessary to define the significance of the radiological findings and also to define the radiological progression.
KEY WORDS:
Active surveillance, magnetic resonance imaging of prostate, prostate carcinoma, targeted biopsy.
Sources
1. Prostate Cancer Research International: Active Surveillance. Active surveillance of early prostate cancer. PRIAS Web site. http://www.prias‑project. org. Accessed November 14, 2011.
2. Král M, Študent V ml, Grepl M, et al. Aktivní sledování u karcinomu prostaty. Ces Urol 2014; 18(3): 208–215.
3. Draisma G, Boer R, Otto SJ, et al. Lead times and overdetection due to prostate‑specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst. 2003; 95: 868–878.
4. Vargas HA, Akin O, Afaq A, et al. Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol 2012; 188: 1732–1738.
5. Bokhorst LP, Valdagni R, Rannikko A, et al. A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment. Eur Urol 2016; 70: 954–960.
6. de Rooij M, Hamoen EH, Fütterer JJ, Barentsz JO, Rovers MM. Accuracy of multiparametric MRI for prostate cancer detection: a meta‑analysis. Am J Roentgenol 2014; 202: 343–351.
7. Wysock JS, Rosenkrantz AB, Huang WC, et al. A prospective, blinded comparison of magnetic resonance (MR) imaging – ultrasound fusion and visual estimation in the performance of MR‑targeted prostate biopsy: the PROFUS trial. Eur Urol 2014; 66: 343–351.
8. The National Institute for Health and Care Excellence. Nice guidelines. Available from: http: //www. nice.org.uk/guidance/cg175/chapter/key‑priorities‑for‑implementation.
9. Tosoian JJ, Loeb S, Epstein JI, et al. Active surveillance of prostate cancer: use, outcomes, imaging, and diagnostic tools. In American Society of Clinical Oncology educational book/ASCO. American Society of Clinical Oncology. Meeting (Vol. 35, p. e235). NIH Public Access.2016.
10. Radiology ACo. PI‑RADS™Prostate Imaging and Reporting and Data System v2.http://wwwacrorg/~/ media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADSV2pdf. 2015.
11. Schoots IG, Petrides N, Giganti F, et al. Magnetic resonance imaging in active surveillance of prostate cancer: a Systematic review. Eur Urol 2015; 67: 627–636.
12. Park BH, Jeon HG, Choo SH, et al. Role of multiparametric 3.0-Tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance. BJU Int 2014; 113: 864–870.
13. Berglund RK, Masterson TA, Vora KC, et al. Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance. J Urol 2008; 180: 1964–1968.
14. Bul M, Zhu X, Valdagni R, et al. Active surveillance for low‑risk prostate cancer worldwide: the PRIAS study. Eur Urol 2013; 63: 597–603.
15. Hu JC, Chang E, Natarajan S, et al. Targeted prostate biopsy in select men for active surveillance – do the Epstein criteria still apply? J Urol 2014; 192: 385–390.
16. Čapoun O, Babjuk M, Dvořáček J, et al. Predikce patologické klasifikace karcinomu prostaty. Ces Urol 2008; 12(1): 31–36.
17. Král M, Študent V, Vidlář A, Hrabec M, Marek D. Nomogram predikce up‑gradingu Gleasonova skóre v biopsii prostaty. Ces Urol 2007; 11: 159–163.
18. Dall’Era MA, Cowan JE, Simko J, et al. Surgical management after active surveillance for low‑risk prostate cancer: pathological outcomes compared with men undergoing immediate treatment. BJU Int. 2011; 107: 1232–1237.
19. Bul M, Zhu X, Rannikko A, et al. Radical prostatectomy for low‑risk prostate cancer following initial active surveillance: Results from a prospective observational study Eur Urol 2012; 62(2): 95–200.
20. Moldovan PC, Van den Broeck T, Sylvester R, et al. What Is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? a systematic review and meta‑analysis
from the European Association of Urology Prostate Cancer Guidelines Panel. Eur Urol 2017.
21. Fütterer JJ, Briganti A, De Visschere P, et al. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging? a systematic review of the literature. Eur Urol 2015; 68: 1045–1053.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2017 Issue 3
Most read in this issue
- THE SIGNIFICANCE OF MRI IN DIAGNOSING PENILE FRACTURE IN A CASE REPORT OF A 16-YEAR-OLD BOY
- THE ROLE OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN ACTIVE SURVEILLANCE OF PROSTATE CANCER
- ILICOURETERAL FISTULA AS A CAUSE OF LIFE-THREATENING HAEMATURIA
- LAPAROSCOPIC RESECTION OF STENOSIS OF URETER – VIDEO