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Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy
Published on: April 9, 2019
Association of Baseline Magnetic Resonance Imaging Prostate Imaging Reporting and Data System Score With Prostate
Kiran R Nandalur1, Chen Shen2, Lili Zhao2
1Department of Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
Purpose:
The purpose of our study was to evaluate the association of baseline MRI Prostate Imaging Reporting and Data System (PI-RADS) score with biopsy reclassification in a multicenter active surveillance (AS) cohort.
Materials And Methods:
We identified men in the Michigan Urological Surgery Improvement Collaborative registry (46 hospital-based/academic/private practice urology groups) with National Comprehensive Cancer Network (NCCN) low-risk and favorable intermediate-risk prostate cancer who underwent MRI within 6 months before or after initial biopsy and enrolled in 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.
Results:
A total of 1491 men were included with median age 64 years (IQR: 59-69) with median follow-up 11.0 months (IQR: 6.0-23.0) after landmark. Baseline PI-RADS ≥ 4 lesion was associated with an increased hazard of biopsy reclassification (HR: 2.3 [95% 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).
Conclusions:
In this multicenter cohort study of real-world data, baseline MRI PI-RADS score was significantly associated with early biopsy reclassification in men undergoing AS with NCCN low- or favorable intermediate-risk prostate cancer.
Insights
A higher Prostate Imaging Reporting and Data System (PI-RADS) score on MRI is linked to a greater risk of biopsy reclassification in men with low-risk prostate cancer on active surveillance (AS). This finding aids in managing prostate cancer progression.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Active surveillance (AS) is a management strategy for low-risk prostate cancer.
- Accurate risk stratification is crucial for effective AS.
- Multiparametric MRI (mpMRI) with PI-RADS scoring is increasingly used in prostate cancer assessment.
Purpose of the Study:
- To evaluate the association between baseline MRI Prostate Imaging Reporting and Data System (PI-RADS) score and biopsy reclassification in men undergoing AS.
- To determine if baseline PI-RADS score predicts progression to higher-grade prostate cancer during AS.
Main Methods:
- A multicenter cohort study identified men with National Comprehensive Cancer Network (NCCN) low-risk and favorable intermediate-risk prostate cancer enrolled in AS.
- Men underwent MRI within 6 months of initial biopsy.
- Multivariable Cox regression models analyzed the association of baseline PI-RADS score (≥4 lesion) with reclassification to high-grade prostate cancer (≥grade group 3) on surveillance biopsy, adjusting for relevant factors.
Main Results:
- A total of 1491 men were included.
- A baseline PI-RADS score of 4 or higher was significantly associated with an increased hazard of biopsy reclassification (HR: 2.3).
- Higher grade group (2 vs 1) and increasing age also predicted reclassification.
Conclusions:
- Baseline MRI PI-RADS score is a significant predictor of early biopsy reclassification in men with low- or favorable intermediate-risk prostate cancer on AS.
- These findings support the utility of baseline MRI PI-RADS scoring in guiding AS management decisions.
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