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AUA 2017

AUA 2017: Multiparametric-MRI Prior To Repeat Biopsy For Active Surveillance Can Identify Men With High-risk Prostate Cancer

Boston, MA (UroToday.com) Active surveillance (AS) is a viable treatment option for men with low risk prostate cancer (PCa). To date no biomarker, including PSA is able to substitute for repeat prostate biopsies to reliably monitor men for disease progression. Multi-parametric MRI (mpMRI) has emerged as the imaging modality of choice for localized PCa. The aim of this study, presented by Dr. Hubner, was to identify men with higher risk disease using mpMRI and eliminate the need for repeat biopsy.

The authors queried their institutional database for all men with low risk PCa initially managed with AS (n=85). All men underwent 1.5 T with endorectal coil mpMRI prior to repeat biopsy. All mpMRI were re-reviewed and all lesions were classified according to the PIRADSv2. All biopsies were trans-rectal including 12 cores at least and were performed with or without fusion technology. All MRI lesion graded PIRADS 3-5 were targeted with extra cores. The primary outcome was disease reclassification, defined by higher Gleason score on repeat biopsy.

The median interval between MRI and repeat biopsy was 2.6 months. 67% percent of men (57/86) showed at least one PIRADS 4 or 5 lesion. Twenty-seven (31%) of men had disease reclassification on confirmatory biopsy including seven men with Gleason 8 or 9 disease. 18.5% of men with no identifiable or PIRADS 1-3 lesions had grade reclassification compared with 42% of men with PIRADS 4 or 5 lesions. (p=0.03). All grade reclassification in patients with lesions characterized as PIRADS 3 or less was from 3+3 to 3+4. Of the 42% of men with PIRADS 4 or 5 lesions who reclassified on confirmatory biopsy, 7/57 (12%) reclassified to Gleason 8 or 9 on confirmatory biopsy.

Dr. Hubner concluded his presentation by stating that mpMRI using PIRADSv2 is likely a suitable way to monitor patients and delay confirmatory biopsy if no or low PIRADS <=3 lesions are present. Men with PIRADS 4 or 5 lesions are at higher risk for reclassification, including to Gleason 8-10 disease after repeat biopsy. Lastly, results on ongoing studies like the RAPID-trial (comparing PSMA-Pet-MRI fusion biopsy results with prostatectomy specimen) will add to the growing body of knowledge on prostate MRI utilization.

Presented by: Hubner N, London, Ontario, Canada

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre Twitter: @Goldberghanan at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA