Prostate cancer: MRI-guided confirmatory biopsy can inform active surveillance

  • Jayadevan R & al.
  • JAMA Netw Open
  • 4 Sep 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with low-risk prostate cancer, MRI-guided confirmatory biopsy findings are associated with future risk of disease upgrade.
  • Adopting only targeted or systematic biopsy can miss up to 45% of upgrades.

Why this matters

  • MRI-guided confirmatory biopsy is an appropriate entry point for active surveillance.

Study design

  • Study of 332 men with Gleason grade group (GG) ≤2 prostate cancer undergoing active surveillance.
  • Confirmatory MRI-guided biopsy was performed within 1 year of initial diagnostic biopsy.
  • Funding: National Cancer Institute.

Key results

  • 114 patients had normal findings on confirmatory biopsy, 175 had GG1 disease, and 43 had GG2 disease.
  • Median follow up: 3.9 years.
  • 11.7% of patients upgraded to GG≥3 disease (confirmatory biopsy findings: normal, 7.9%; GG1, 11.4%; GG2, 23.3% [P=.03]).
  • In patients with low PSA density (
  • GG1 disease also increased upgrade risk (HR, 3.3; 95% CI, 1.3-8.4).
  • PSA density ≥0.15 ng/mL/mL was tied to increased risk for upgrade in patients with normal findings (HR 7.21; 95% CI, 1.98-26.24) and GG1 disease (HR 2.86; 95% CI, 1.16-7.03).
  • 45% of upgrades were missed by targeted biopsy and 41% by systematic biopsy.
  • Limitations

    • Retrospective design.