OBJECTIVE: To evaluate predictors of more aggressive disease and the role of multiparametric 3.0-T magnetic resonance imaging (MRI) in selecting prostate cancer patients for active surveillance.
PATIENTS AND METHODS: We retrospectively assessed 298 prostate cancer patients who met the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, defined as T1c/T2, PSA level of ≤ 10 ng/mL, PSA density of < 0.2 ng/mL2 , Gleason score < 7, and one or two positive biopsy cores. All patients underwent preoperative MRI, including T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging, as well as radical prostatectomy between June 2005 and December 2011. Imaging results were correlated with pathological findings to evaluate the ability of MRI to select patients for active surveillance.
RESULTS: In 35(11.7%) patients, no discrete cancer was visible on MRI while in the remaining 263(88.3%) patients, a discrete cancer was visible. Pathologic examination of radical prostatectomy specimens resulted in upstaging (>T2) in 21(7%) patients, upgrading (Gleason score >6) in 136(45.6%), and a diagnosis of unfavorable disease in 142(47.7%) patients. The 263 patients(88.3%) with visible cancer on imaging were more likely to have their cancer status upgraded(49.8% vs. 14.3%) and be diagnosed with unfavorable disease(52.1% vs. 14.3%) than the 35 patients(11.7%) with no cancer visible upon imaging, and these differences were statistically significant(p< 0.001 for all). A visible cancer lesion on MRI, PSA density, and patient age were found to be predictors of unfavorable disease in multivariate analysis.
CONCLUSIONS: MRI can predict adverse pathologic features and be used to assess the eligibility of prostate cancer patients for active surveillance.
Written by:
Park BH, Jeon HG, Choo SH, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Are you the author?
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Reference: BJU Int. 2013 Aug 23. Epub ahead of print.
doi: 10.1111/bju.12423
PubMed Abstract
PMID: 24053308
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