Magnetic Resonance Imaging Targeted Biopsy Improves Selection of Patients Considered for Active Surveillance for Clinically Low Risk Prostate Cancer Based on Systematic Biopsies.
OBJECTIVE
Current selection criteria for active surveillance based on systematic biopsy underestimate prostate cancer volume and grade. We investigated the role of additional magnetic resonance imaging targeted biopsy in reclassifying patients eligible for active surveillance based on systematic biopsy.


METHODS
We performed a study at 2 institutions in a total of 281 men with increased prostate specific antigen. All men met certain criteria, including 1) prebiopsy magnetic resonance imaging, 12-core transrectal systematic biopsy and 2 additional magnetic resonance imaging targeted biopsies of lesions suspicious for cancer during the same sequence as systematic biopsy, and 2) eligibility for active surveillance based on systematic biopsy results. Criteria for active surveillance were prostate specific antigen less than 10 ng/ml, no Gleason grade 4/5, 5 mm or less involvement of any biopsy core and 2 or fewer positive systematic biopsy cores. Patient characteristics were compared between reclassified and nonreclassified groups based on magnetic resonance imaging targeted biopsy results.


RESULTS
On magnetic resonance imaging 58% of the 281 patients had suspicious lesions. Magnetic resonance imaging targeted biopsy was positive for cancer in 81 of 163 patients (50%). Of 281 patients 28 (10%) were reclassified by magnetic resonance imaging targeted biopsy as ineligible for active surveillance based on Gleason score in 8, cancer length in 20 and Gleason score plus cancer length in 9. Suspicious areas on magnetic resonance imaging were in the anterior part of the prostate in 15 of the 28 men (54%). Reclassified patients had a smaller prostate volume (37 vs 52 cc) and were older (66.5 vs 63 years) than those who were not reclassified (p < 0.05).


CONCLUSIONS
Magnetic resonance imaging targeted biopsy reclassified 10% of patients who were eligible for active surveillance based on systematic biopsy. Its incorporation into the active surveillance eligibility criteria may decrease the risk of reclassification to higher stages during followup.
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France. Electronic address: adil-ouzzane@orange.fr.
Adil
A
Ouzzane
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
Raphaele
R
Renard-Penna
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
François
F
Marliere
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
Pierre
P
Mozer
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
Jonathan
J
Olivier
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
Johann
J
Barkatz
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
Philippe
P
Puech
Department of Urology (AO, FM, JO, AV), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Department of Radiology (PP), Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France; Inserm U1189 ONCO-THAI, Centre Hospitalier Régional Universitaire Lille, Université de Lille (AO, PP, AV), Loos, France; Department of Radiology (RR-P), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology (PM), Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
Arnauld
A
Villers
D062005:Biopsy, Large-Core Needle / Q000379:methods*; D005602:France; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D060787:Neoplasm Grading; D018579:Patient Selection; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018426:SEER Program
biopsy; diagnostic imaging; magnetic resonance imaging; prostatic neoplasms; watchful waiting