title: Prostate cancer: can multiparametric MR imaging help identify patients who are candidates for active surveillance?
abstract: OBJECTIVE
  To determine whether multiparametric magnetic resonance (MR) imaging can help identify patients with prostate cancer who would most appropriately be candidates for active surveillance (AS) according to current guidelines and to compare the results with those of conventional clinical assessment scoring systems, including the D'Amico, Epstein, and Cancer of the Prostate Risk Assessment (CAPRA) systems, on the basis of findings at prostatectomy.
  
  
  METHODS
  This institutional review board-approved HIPAA-compliant retrospectively designed study included 133 patients (mean age, 59.3 years) with a mean prostate-specific antigen level of 6.73 ng/mL (median, 4.39 ng/mL) who underwent multiparametric MR imaging at 3.0 T before radical prostatectomy. Informed consent was obtained from all patients. Patients were then retrospectively classified as to whether they would have met AS eligibility criteria or were better served by surgery. AS eligibility criteria for prostatectomy specimens were a dominant tumor smaller than 0.5 mL without Gleason 4 or 5 patterns or extracapsular or seminal vesicle invasion. Conventional clinical assessment scores (the D'Amico, Epstein, and CAPRA scoring systems) were compared with multiparametric MR imaging findings for predicting AS candidates. The level of significance of difference between scoring systems was determined by using the χ(2) test for categoric variables with the level of significance set at P < .05.
  
  
  RESULTS
  Among 133 patients, 14 were eligible for AS on the basis of prostatectomy results. The sensitivity, positive predictive value (PPV), and overall accuracy, respectively, were 93%, 25%, and 70% for the D'Amico system, 64%, 45%, and 88% for the Epstein criteria, and 93%, 20%, and 59% for the CAPRA scoring system for predicting AS candidates (P < .005 for all, χ(2) test), while multiparametric MR imaging had a sensitivity of 93%, a PPV of 57%, and an overall accuracy of 92% (P < .005).
  
  
  CONCLUSIONS
  Multiparametric MR imaging provides useful additional information to existing clinicopathologic scoring systems of prostate cancer and improves the assignment of treatment (eg, AS or active treatment).
authors.affiliation: Molecular Imaging Program, Laboratory of Pathology, Radiation Oncology Branch, and Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1182 Bldg 10, Room B3B69, Bethesda, MD 20892-1088, USA.
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
authors.forename: Haresh
authors.initials: H
authors.lastname: Mani
authors.forename: Omer
authors.initials: O
authors.lastname: Aras
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ho
authors.forename: Anthony
authors.initials: A
authors.lastname: Hoang
authors.forename: Ardeshir R
authors.initials: AR
authors.lastname: Rastinehad
authors.forename: Harsh
authors.initials: H
authors.lastname: Agarwal
authors.forename: Vijay
authors.initials: V
authors.lastname: Shah
authors.forename: Marcelino
authors.initials: M
authors.lastname: Bernardo
authors.forename: Yuxi
authors.initials: Y
authors.lastname: Pang
authors.forename: Dagane
authors.initials: D
authors.lastname: Daar
authors.forename: Yolanda L
authors.initials: YL
authors.lastname: McKinney
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Aradhana
authors.initials: A
authors.lastname: Kaushal
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D017430:Prostate-Specific Antigen; D019786:Gadolinium DTPA