Prostate cancer: MRI precludes biopsy in 70% patients of undergoing active surveillance

  • Amin A & al.
  • J Urol
  • 11 Dec 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Annual surveillance multiparametric MRI (mpMRI) precludes biopsy for 3 years in 71% of patients with low-grade prostate cancer undergoing active surveillance.
  • Because mpMRI misses a small number of significant high-grade tumors, these authors do not recommend skipping biopsies for >3 years.

Why this matters

  • Clinicians should discuss with patients the risks and benefits of replacing annual biopsy.

Study design

  • An interim analysis of the Magnetic Resonance Imaging in Active Surveillance (MRIAS) trial.
  • 100 patients with cT2 or lower histologically proven prostate cancer were eligible for active surveillance.
  • Patients received annual mpMRI.
  • Abnormal findings on mpMRI and PSA triggered surveillance biopsy.
  • Funding: None.

Key results

  • The mpMRI was negative (Prostate Imaging Reporting and Data System 1/2/3) in 87 patients at baseline.
  • The median follow-up was 36 months.
  • The detection of clinically significant prostate cancer (csPCa) was significantly lower in 71 patients with a negative vs 29 patients with a positive surveillance mpMRI (11.3% vs 44.8%; P<.001>
  • With surveillance mpMRI for detection of csPCa:
    • Sensitivity, 61%.
    • Specificity, 80%.
    • Positive predictive value, 45%.
    • Negative predictive value, 89%.
  • Significant predictors of csPCa:
    • Positive surveillance MRI (aOR, 5.73; P=.002).
    • PSA density >0.2 ng/mL (OR, 4.44; P=.042).

Limitations

  • No comparator group.