The purpose of our study was to evaluate the association of baseline MRI PI-RADS score with biopsy reclassification in a multicenter active surveillance cohort.
We identified men in the Michigan Urological Surgery Improvement Collaborative registry (46 hospital based/academic/private practice urology groups) with NCCN low risk and favorable intermediate risk prostate cancer who underwent MRI within 6 months before or after initial biopsy and enrolled in active surveillance (AS) from June 2016 to January 2021. The primary objective was to determine the association of baseline MRI PI-RADS score (≥4 lesion) with reclassification to high-grade prostate cancer (≥grade group 3) on surveillance biopsy. Multivariable Cox proportional hazards regression models were constructed and adjusted for pathologic, MRI, and clinical/biopsy factors, with landmark time of 6 months from diagnostic biopsy. We included an interaction term between PI-RADS score and NCCN group in the Cox model.
Total of 1491 men were included with median age 64 years (interquartile range (IQ): 59-69) with median follow-up 11.0 months (IQ: 6.0-23.0) after landmark. Baseline PI-RADS ≥ 4 lesion was associated with an increased hazard of biopsy reclassification (Hazard ratio (HR): 2.3 (95% confidence interval (CI): 1.6-3.2), P < .001), along with grade group 2 vs 1 (HR: 2.5 (95%CI: 1.7-3.7), P < .001), and increasing age (per 10 years) (HR: 1.8 (95%CI: 1.4-2.4), P < .001). The interaction between NCCN risk group with MRI findings was not significant (P = .7).
In this multicenter cohort study of real-world data, baseline MRI PI-RADS score was significantly associated with early biopsy reclassification in men undergoing active surveillance with NCCN low or favorable intermediate risk prostate cancer.
The Journal of urology. 2024 Jun 25 [Epub ahead of print]
Kiran R Nandalur, Chen Shen, Lil Zhao, Sayf Al-Katib, Joseph Lee, Brian Seifman, Hong Ye, Kevin Ginsburg, Thomas Quinn, Sirisha Nandalur, Arvin George, David Gangwish, Abhay Dhaliwal, Connor Erwin, Amanda Young, Akram Albeer, Jason Hafron
Department of Radiology and Molecular Imaging, William Beaumont University Hospital, Royal Oak, Michigan., Biostatistics and Health Informatics, Corewell Health Research Institute, Royal Oak, Michigan., Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, Michigan., Department of Urology, William Beaumont University Hospital, Royal Oak, Michigan., Department of Urology, Wayne State University, Detroit, Michigan., Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland., Michigan Institute of Urology, West Bloomfield, Michigan.