Abnormal findings on multiparametric prostate magnetic resonance imaging predict subsequent biopsy upgrade in patients with low risk prostate cancer managed with active surveillance
To determine the ability of multiparametric MR imaging to predict disease progression in patients with prostate cancer managed by active surveillance.
Sixty-four men with biopsy-proven prostate cancer managed by active surveillance were included in this HIPPA compliant, IRB approved study. We reviewed baseline MR imaging scans for the presence of a suspicious findings on T2-weighted imaging, MR spectroscopic imaging (MRSI), and diffusion-weighted MR imaging (DWI). The Gleason grades at subsequent biopsy were recorded. A Cox proportional hazard model was used to determine the predictive value of MR imaging for Gleason grades, and the model performance was described using Harrell’s C concordance statistic and 95% confidence intervals (CIs).
The Cox model that incorporated T2-weighted MR imaging, DWI, and MRSI showed that only T2-weighted MR imaging and DWI are independent predictors of biopsy upgrade (T2; HR = 2.46; 95% CI 1.36–4.46; P = 0.003—diffusion; HR = 2.76; 95% CI 1.13–6.71; P = 0.03; c statistic = 67.7%; 95% CI 61.1–74.3). There was an increasing rate of Gleason score upgrade with a greater number of concordant findings on multiple MR sequences (HR = 2.49; 95% CI 1.72–3.62; P < 0.001).
Abnormal results on multiparametric prostate MRI confer an increased risk for Gleason score upgrade at subsequent biopsy in men with localized prostate cancer managed by active surveillance. These results may be of help in appropriately selecting candidates for active surveillance.
KeywordsProstate cancer Active surveillance Magnetic resonance imaging Magnetic resonance spectroscopic imaging Diffusion-weighted magnetic resonance imaging
- 14.Somford DM, Hambrock T, Hulsbergen-van de Kaa CA, et al. (2012) Initial experience with identifying high-grade prostate cancer using diffusion-weighted MR imaging (DWI) in patients with a Gleason score ≤ 3 + 3 = 6 upon schematic TRUS-guided biopsy: a radical prostatectomy correlated series. Investig Radiol 47(3):153–158. doi:10.1097/RLI.0b013e31823ea1f0 Google Scholar
- 16.Itou Y, Nakanishi K, Narumi Y, Nishizawa Y, Tsukuma H (2011) Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: can ADC values contribute to assess the aggressiveness of prostate cancer? J Magn Reson Imaging 33(1):167–172. doi:10.1002/jmri.22317 PubMedCrossRefGoogle Scholar
- 21.Lee DH, Koo KC, Lee SH, et al. (2013) Tumor lesion diameter on diffusion weighted magnetic resonance imaging could help predict insignificant prostate cancer in patients eligible for active surveillance: preliminary analysis. J Urol 190(4):1213–1217. doi:10.1016/j.juro.2013.03.127 PubMedCrossRefGoogle Scholar
- 26.Park BH, Jeon HG, Choo SH, et al. (2013) Role of multiparametric 3.0 tesla magnetic resonance imaging in prostate cancer patients eligible for active surveillance. BJU Int. doi:10.1111/bju.12423.
- 28.Guzzo TJ, Resnick MJ, Canter DJ, et al. (2012) Endorectal T2-weighted MRI does not differentiate between favorable and adverse pathologic features in men with prostate cancer who would qualify for active surveillance. Urol Oncol 30(3):301–305. doi:10.1016/j.urolonc.2010.08.023 PubMedCrossRefGoogle Scholar
- 29.Ploussard G, Xylinas E, Durand X, et al. (2011) Magnetic resonance imaging does not improve the prediction of misclassification of prostate cancer patients eligible for active surveillance when the most stringent selection criteria are based on the saturation biopsy scheme. BJU Int 108(4):513–517. doi:10.1111/j.1464-410X.2010.09974.x PubMedCrossRefGoogle Scholar
- 30.Cabrera AR, Coakley FV, Westphalen AC, et al. (2008) Prostate cancer: is inapparent tumor at endorectal MR and MR spectroscopic imaging a favorable prognostic finding in patients who select active surveillance? Radiology 247(2):444–450. doi:10.1148/radiol.2472070770 PubMedCrossRefPubMedCentralGoogle Scholar
- 35.Margel D, Yap SA, Lawrentschuk N, et al. (2012) Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: a prospective cohort study. J Urol 187(4):1247–1252. doi:10.1016/j.juro.2011.11.112 PubMedCrossRefGoogle Scholar
- 37.Hoeks CM, Somford DM, van Oort IM, et al. (2013) Value of 3-T multiparametric magnetic resonance imaging and magnetic resonance-guided biopsy for early risk restratification in active surveillance of low-risk prostate cancer: a prospective multicenter cohort study. Invest Radiol . doi:10.1097/RLI.0000000000000008 Google Scholar
- 39.Bonekamp D, Bonekamp S, Mullins JK, et al. (2013) Multiparametric magnetic resonance imaging characterization of prostate lesions in the active surveillance population: incremental value of magnetic resonance imaging for prediction of disease reclassification. J Comput Assist Tomogr 37(6):948–956. doi:10.1097/RCT.0b013e31829ae20a PubMedCrossRefGoogle Scholar
- 42.International Scientific Cooperation to Advance Image-Guided Prostate Cancer Care (2012) American College of Radiology News Releases. Reston: International Scientific Cooperation to Advance Image-Guided Prostate Cancer Care Google Scholar