To evaluate the integration of 3T non-endorectal-coil multiparametric prostate MRI (mpMRI) at two high-volume practices that routinely use mpMRI in the setting of active surveillance.
This was an IRB-approved, HIPAA-compliant, dual-institution retrospective cohort study. Subjects undergoing 3T mpMRI without endorectal coil at either study institution over a 13-month period (8/1/2015-8/31/2016) were selected based on pre-defined criteria: clinical T1/T2 Gleason 6 prostate cancer, PSA<15 ng/mL, ≥40 years-old, mpMRI within 2 years of prostate biopsy, PI-RADS v2 score assigned. Subjects surveilled for Gleason ≥3+4 prostate cancer were excluded. The primary outcome was detection of Gleason ≥3+4 prostate cancer on ultrasound-MR fusion biopsy, standard biopsy, or prostatectomy within 6 months following mpMRI. Positive predictive values (PPV) were calculated.
286 subjects (N=193 from institution 1, N=93 from institution 2) met criteria. Most (87% [90/104]) with maximum PI-RADS v2 scores 1-2 did not receive immediate biopsy or treatment and remained on active surveillance. Incidence and positive predictive values for PI-RADS v2 scores ≥3 were: PI-RADS 3 (n=57 [20%], PPV: 21% [6/29]), PI-RADS 4 (n=96 [34%], PPV: 51% [39/77]), PI-RADS 5 (n=29 [13%], PPV: 71% [20/28]). No Gleason ≥4+3 prostate cancer was identified for PI-RADS v2 scores of 1-3 (0/43 with histology). Following mpMRI and subsequent biopsy, 21% (61/286) of subjects were removed from active surveillance and underwent definitive therapy.
3T non-endorectal coil mpMRI has been integrated into the care of patients on active surveillance and effectively stratifies risk of Gleason ≥3+4 prostate cancer in this population.
Urology. 2018 Apr 10 [Epub ahead of print]
Nicole E Curci, Brian R Lane, Prasad R Shankar, Sabrina L Noyes, Andrew K Moriarty, Anthony Kubat, Chris Brede, Jeffrey S Montgomery, Gregory B Auffenberg, David C Miller, James E Montie, Arvin K George, Matthew S Davenport
Department of Radiology, Michigan Medicine, Ann Arbor MI. Electronic address: ., Department of Urology, Spectrum Health Medical Group. Electronic address: ., Department of Radiology, Michigan Medicine, Ann Arbor MI. Electronic address: ., Department of Urology, Spectrum Health Medical Group. Electronic address: ., Advanced Radiology Services, Spectrum Health Medical Group. Electronic address: ., Department of Pathology, Spectrum Health Medical Group. Electronic address: ., Department of Urology, Spectrum Health Medical Group. Electronic address: ., Department of Urology, Michigan Medicine, Ann Arbor MI. Electronic address: ., Department of Urology, Michigan Medicine, Ann Arbor MI. Electronic address: ., Department of Urology, Michigan Medicine, Ann Arbor MI. Electronic address: ., Department of Urology, Michigan Medicine, Ann Arbor MI. Electronic address: ., Department of Urology, Michigan Medicine, Ann Arbor MI. Electronic address: ., Department of Radiology, Michigan Medicine, Ann Arbor MI; Department of Urology, Michigan Medicine, Ann Arbor MI; Michigan Radiology Quality Collaborative. Electronic address: .