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.
OBJECTIVE
The objective of this study was to evaluate the role of 3-T multiparametric magnetic resonance imaging (MP-MRI) and magnetic resonance-guided biopsy (MRGB) in early risk restratification of patients on active surveillance at 3 and 12 months of follow-up.


METHODS
Within 4 hospitals participating in a large active surveillance trial, a side study was initiated. Pelvic magnetic resonance imaging, prostate MP-MRI, and MRGB were performed at 3 and 12 months (latter prostate MP-MRI and MRGB only) after prostate cancer diagnosis in 1 of the 4 participating hospitals. Cancer-suspicious regions (CSRs) were defined on prostate MP-MRI using Prostate Imaging Reporting And Data System (PI-RADS) scores.Risk restratification criteria for active surveillance discontinuance were (1) histopathologically proven magnetic resonance imaging suspicion of node/bone metastases and/or (2) a Gleason growth pattern (GGP) 4 and/or 5 and/or cancer multifocality (≥3 foci) in MRGB specimens of a CSR on MP-MRI.


RESULTS
From 2009 to 2012, a total of 64 of 82 patients were consecutively and prospectively included and underwent MP-MRI and a subsequent MRGB. At 3 and 12 months of follow-up, 14% (9/64) and 10% (3/30) of the patients were risk-restratified on the basis of MP-MRI and MRGB. An overall CSR PI-RADS score of 1 or 2 had a negative predictive value of 84% (38/45) for detection of any prostate cancer and 100% (45/45) for detection of a GGP 4 or 5 containing cancer upon MRGB, respectively. A CSR PI-RADS score of 4 or higher had a sensitivity of 92% (11/12) for detection of a GGP 4 or 5 containing cancer upon MRGB.


CONCLUSIONS
Application of MP-MRI and MRGB in active surveillance may contribute in early identification of patients with GGP 4 or 5 containing cancers at 3 months of follow-up. If, during further follow-up, a PI-RADS score of 1 or 2 continues to have a negative predictive value for GGP 4 or 5 containing cancers, a PI-RADS standardized reported MP-MRI may be a promising tool for the selection of prostate cancer patients suitable for active surveillance.
From the Departments of *Radiology, and †Urology, Radboud University Nijmegen Medical Centre; ‡Department of Urology, Canisius Wilhelmina Hospital, Nijmegen; §Department of Urology, Jeroen Bosch Hospital, Den Bosch; ∥Department of Urology, Alysis Zorggroep, Arnhem; ¶Department of Urology, Erasmus University Medical Centre, Rottterdam; and #Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Caroline M A
CM
Hoeks
Diederik M
DM
Somford
Inge M
IM
van Oort
Henk
H
Vergunst
Jorg R
JR
Oddens
Geert A
GA
Smits
Monique J
MJ
Roobol
Meelan
M
Bul
Thomas
T
Hambrock
J Alfred
JA
Witjes
Jurgen J
JJ
Fütterer
Christina A
CA
Hulsbergen-van de Kaa
Jelle O
JO
Barentsz
D000368:Aged; D015331:Cohort Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D061705:Image-Guided Biopsy / Q000379:methods / Q000706:statistics & numerical data*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity