Multiparametric Magnetic Resonance in Predicting Progression of Low-Risk Prostate Cancer

Evaluated Data

The medical records of patients who underwent mpMRI before radical prostatectomy between 2014 and 2018 were analyzed. PI-RADS v2 scores were determined for 12 regions of the prostate. All patients met the international criteria for active surveillance of prostate cancer (PRIAS – Prostate Cancer Research International AS): Gleason score (GS) from needle biopsy ≤ 6, prostate-specific antigen (PSA) ≤ 10 ng/ml, PSA density < 0.2 ng/ml/ml, clinical stage T1c or T2, and ≤ 2 positive biopsy samples.

Patients were divided into 3 groups according to the AJCC prognostic stage:

1. Stage I – pathological stage T2 and GS 6,
2. Stage IIB – T2 and GS 3+4,
3. Stage ≥ IIC – T3 or GS ≥ 4+3

Results

A total of 376 patients were included, of which 48.9% were in stage I, 34.3% in stage IIB, and 16.8% in stage IIC–III. Patients with stage ≥ IIC were older and had higher PSA density. They were more frequently found to have lesions with a PI-RADS score of 5. Multivariate analysis showed that the independent predictor of unfavorable disease status was ≥ 2 lesions with a PI-RADS score of 5. The hazard ratio (HR) compared to stage I patients was 3.612 for stage IIB (p < 0.001) and 6.562 for stage IIC–III (p < 0.001). A PI-RADS score ≥ 4 was a predictor only for stage IIB (HR 2.387; p = 0.01).

Conclusion

Multiparametric magnetic resonance imaging allows the identification of patients with low-risk prostate cancer for whom targeted biopsy or radical prostatectomy should be considered.

(zza)

Source: Kim H., Pak S., Park K. J. et al. Utility of multiparametric magnetic resonance imaging with PI-RADS, version 2, in patients with prostate cancer eligible for active surveillance: which radiologic characteristics can Predict unfavorable disease? Clin Genitourin Cancer 2020 Feb; 18(1): 50−55, doi: 10.1016/j.clgc.2019.09.018.