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EAU 2019

EAU 2019: MRI Alone Should Not be Considered as a Stand-alone Test for Disease Reclassification of Men in Active Surveillance

Barcelona, Spain (UroToday.com) The utilization of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis and management of prostate cancer has increased significantly over the last several years, as multiple studies have suggested it can add clinically actionable information. One such area in which mpMRI is being increasingly studied is for patients on active surveillance (AS) protocols for low-risk disease.  One of the significant challenges of AS is that it is often difficult to predict which men are at increased risk of clinical progression or upgrading of their disease while they are undergoing surveillance. The significance of disease reclassification for a man on an active surveillance protocol is that they are then typically offered treatment with prostatectomy, radiation therapy, or other ablative techniques and are therefore exposed to the potential morbidities of these treatment options.

As part of the 2019 European Association of Urology (EAU) Annual meeting in Barcelona, Spain, Dr. Marco Roscgino presented a multi-institutional retrospective study which sought to evaluate if mpMRI alone could be used alone to help determine which men are at risk of reclassification, or upgrading of their disease, while on active surveillance.

The group identified 340 patients from January 2016 to September 2018 who underwent mpMRI prior to confirmatory biopsy. Patients with a negative mpMRI (PI-RADS score 1 or 2) underwent a subsequent systemic random biopsy, while patients with a PI-RADS score ≥ 3 underwent targeted biopsies and systemic random biopsies. They then used logistic regression analysis to create three models to predict the probability of disease reclassification in these patients. The first model included only clinical variables, including patient age, PSA density, and the number of positive cores at initial biopsy. The second model only utilized the PI-RADS score, while the third model utilized both clinical data and PI-RADS score combined.

They then evaluated the predictive accuracy of disease reclassification of each of these three models and found that the third model, which included both clinical variables and the mpMRI data (PI-RADS score) had the highest predictive accuracy of 72%, while the clinical model or PI-RADS models alone had slightly lower predictive accuracy. Clinical factors which had predictive value included PSA density and number of positive cores at initial biopsy. There was also an increased risk of progression with increasing PI-RADS score. They found that the combination of both clinical and radiographic features provides the best diagnostic accuracy for disease reclassification, however.

Marco Roscgino and his colleagues concluded that while mpMRI can be of value in the setting of active surveillance, clinical features should still be incorporated into any predictive models of disease upgrading or progression. They cautioned that mpMRI alone is not a sufficient test for disease reclassification in men undergoing active surveillance protocols for low-risk prostate cancer.

Presented by: Marco Roscgino, MD, Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy

Written by: Brian Kadow, MD. Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, Pennsylvania at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019