Complementing the active surveillance criteria with multiparametric magnetic resonance imaging

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Active surveillance (AS) is an option for low-risk prostate cancer (PCa).
• Accurate risk stratification is crucial to avoid misclassification.
• Multiparametric magnetic resonance imaging (mpMRI) may improve diagnostic accuracy.

Purpose of the Study:

• To assess the utility of mpMRI in preventing misclassification of patients with clinically significant PCa into AS.
• To determine if mpMRI can identify patients who might benefit from treatment rather than AS.

Main Methods:

• Retrospective analysis of patients with Gleason grade group (GG) 1 PCa undergoing mpMRI before radical prostatectomy (RP).
• Comparison of mpMRI (PI-RADS scores) and pathology results between AS and NOT-AS candidates.
• Definition of unfavorable disease as T3-4 disease or GG upgrade in RP specimens.

Main Results:

• No significant difference in PI-RADS scores between AS and NOT-AS candidates.
• Among AS candidates, 37.5% had GG upgrading and 39.1% had unfavorable disease post-RP.
• Patients with PI-RADS 5 scores had a significantly higher rate of unfavorable disease (83.3%) compared to those with PI-RADS ≤4 (34.5%).
• PI-RADS 5 lesions in AS candidates were often anterior, with 75% showing GG upgrading on targeted biopsy.

Conclusions:

• PI-RADS scores alone did not significantly differentiate AS candidates from those needing treatment.
• mpMRI, particularly PI-RADS 5 lesions, identified a high rate of unfavorable disease in AS candidates.
• Anterior prostate lesions, including in the transitional zone, may be missed by systematic biopsy but detected by mpMRI.