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Additional findings in prostate MRI
Fabio Porões1,2, Paraskevi Karampa3,4, Thomas Sartoretti3
1University of Fribourg, Fribourg, Switzerland. fabio.ramosporoes@unifr.ch.
Background:
Despite the increasing interest in abbreviated protocols, we adopted an extended protocol for all prostate MRIs. In this study, we assessed the benefits of an extended prostate MRI protocol, measured by the number and the clinical importance of additional findings (AFs) and their impact on patient management.
Methods:
In a single-center study, we retrospectively included 1282 patients undergoing prostate MRI between 01.10.2018 and 30.04.2022. Additional findings were defined as any pathology not located in the prostate or the seminal vesicles. These were classified as related or unrelated to prostate cancer (PCa). The latter were divided into groups based on low, moderate, or high clinical significance (group 1, 2, and 3). A finding unrelated to PCa was judged to be clinically significant (group 2: moderate, group 3: high) if further diagnostic investigations, or treatment was necessary. The degree of urgency of the latter determined moderate and high significance. For group 3 findings, a change in management was defined as further workup.
Results:
A total of 5206 AFs was recorded in 1240/1282 patients. One hundred and twenty-three (2.4% of all findings) extra-prostatic PCa related AFs were found in 106 (8.3% of all patients) patients. The remaining 5083 (97.6% of all findings) findings were not related to PCa, of which 3155 (60.6%), 1770 (34.0%), and 158 (3.0%) were assigned to groups 1, 2, and 3, respectively. A management shift was identified in 49 (3.8% of all patients) patients of group 3.
Conclusion:
The extended prostate MRI protocol shows a considerable prevalence of AFs of which more than a third are clinically significant, related or unrelated to PCa (groups 2 and 3). A substantial percentage (8.3%) of patients have extra-prostatic PCa-related AFs that change the patient's disease stage and management. However, a change in management due to AFs unrelated to PCA that belong to group 3 is observed in less than 4% of all patients. The choice between extended and abbreviated prostate MRI protocols should be made based on available resources.
Insights
Extended prostate MRI protocols identify significant additional findings, including prostate cancer (PCa)-related abnormalities impacting patient management. While many findings are clinically significant, changes in management for non-PCa related findings are less common.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Extended prostate MRI protocols are utilized despite growing interest in abbreviated methods.
- Assessing the clinical value of additional findings (AFs) from extended protocols is crucial for patient care.
Purpose of the Study:
- To evaluate the benefits of an extended prostate MRI protocol.
- To quantify the number and clinical significance of additional findings (AFs).
- To determine the impact of AFs on patient management.
Main Methods:
- Retrospective analysis of 1282 patients undergoing prostate MRI.
- Classification of extra-prostatic findings based on relation to prostate cancer (PCa) and clinical significance (Groups 1-3).
- Evaluation of management changes resulting from significant AFs.
Main Results:
- Over 5000 AFs were identified in 1240 patients.
- Extra-prostatic PCa-related AFs occurred in 8.3% of patients, altering disease stage and management.
- Clinically significant AFs (Groups 2 and 3) represented over one-third of all findings.
Conclusions:
- Extended prostate MRI protocols yield a high prevalence of clinically significant AFs, both PCa-related and unrelated.
- PCa-related extra-prostatic AFs significantly impact patient management in a notable percentage of cases.
- Management changes due to non-PCa related significant AFs are less frequent, suggesting a resource-dependent protocol selection.
