title: 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.
abstract: Study Type - Diagnostic (case series).
  
  
  METHODS
  4.
  
  
  OBJECTIVE
  • To investigate the role of magnetic resonance imaging (MRI) in selecting patients for active surveillance (AS).
  
  
  METHODS
  • We identified prostate cancers patients who had undergone a 21-core biopsy scheme and fulfilled the criteria as follows: prostate-specific antigen (PSA) level ≤ 10 ng/mL, T1-T2a disease, a Gleason score ≤ 6, <3 positive cores and tumour length per core <3 mm. • We included 96 patients who underwent a radical prostatectomy (RP) and a prostate MRI before surgery. • The main end point of the study was the unfavourable disease features at RP, with or without the use of MRI as AS inclusion criterion.
  
  
  RESULTS
  • Mean age and mean PSA were 62.4 years and 6.1 ng/mL, respectively. Prostate cancer was staged pT3 in 17.7% of cases. • The rate of unfavourable disease (pT3-4 and/or Gleason score ≥ 4 + 3) was 24.0%. A T3 disease on MRI was noted in 28 men (29.2%). MRI was not a significant predictor of pT3 disease in RP specimens (P = 0.980), rate of unfavourable disease (P = 0.604), positive surgical margins (P = 0.750) or Gleason upgrading (P = 0.314). • In a logistic regression model, no preoperative parameter was an independent predictor of unfavourable disease in the RP specimen. • After a mean follow-up of 29 months, the recurrence-free survival (RFS) was statistically equivalent between men with T3 on MRI and those with T1-T2 disease (P = 0.853).
  
  
  CONCLUSIONS
  • The results of the present study emphasize that, when the selection of patients for AS is based on an extended 21-core biopsy scheme, and uses the most stringent inclusion criteria, MRI does not improve the prediction of high-risk and/or non organ-confined disease in a RP specimen.
authors.affiliation: INSERM U955 Eq07 Department of Urology and Pathology, APHP, CHU Henri Mondor, Créteil, France. g.ploussard@voila.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Xavier
authors.initials: X
authors.lastname: Durand
authors.forename: Idir
authors.initials: I
authors.lastname: Ouzaïd
authors.forename: Yves
authors.initials: Y
authors.lastname: Allory
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bouanane
authors.forename: Claude-Clément
authors.initials: CC
authors.lastname: Abbou
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D003951:Diagnostic Errors; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality; D018579:Patient Selection; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000401:mortality; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D012680:Sensitivity and Specificity; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen