title: Role of serial multiparametric magnetic resonance imaging in prostate cancer active surveillance.
abstract: OBJECTIVE
  To examine whether addition of 3T multiparametric magnetic resonance imaging (mpMRI) to an active surveillance protocol could detect aggressive or progressive prostate cancer.
  
  
  METHODS
  Twenty-three patients with low risk disease were enrolled on this active surveillance study, all of which had Gleason score 6 or less disease. All patients had clinical assessments, including digital rectal examination and prostate specific antigen (PSA) testing, every 6 mo with annual 3T mpMRI scans with gadolinium contrast and minimum sextant prostate biopsies. The MRI images were anonymized of patient identifiers and clinical information and each scan underwent radiological review without the other results known. Descriptive statistics for demographics and follow-up as well as the sensitivity and specificity of mpMRI to identify prostate cancer and progressive disease were calculated.
  
  
  RESULTS
  During follow-up (median 24.8 mo) 11 of 23 patients with low-risk prostate cancer had disease progression and were taken off study to receive definitive treatment. Disease progression was identified through upstaging of Gleason score on subsequent biopsies for all 11 patients with only 2 patients also having a PSA doubling time of less than 2 years. All 23 patients had biopsy confirmed prostate cancer but only 10 had a positive index of suspicion on mpMRI scans at baseline (43.5% sensitivity). Aggressive disease prediction from baseline mpMRI scans had satisfactory specificity (81.8%) but low sensitivity (58.3%). Twenty-two patients had serial mpMRI scans and evidence of disease progression was seen for 3 patients all of whom had upstaging of Gleason score on biopsy (30% specificity and 100% sensitivity).
  
  
  CONCLUSIONS
  Addition of mpMRI imaging in active surveillance decision making may help in identifying aggressive disease amongst men with indolent prostate cancer earlier than traditional methods.
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Vos
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Michele
authors.initials: M
authors.lastname: Janoski
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Wachowicz
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Atiyah
authors.initials: A
authors.lastname: Yahya
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Oleksandr
authors.initials: O
authors.lastname: Boychak
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Amanie
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Pervez
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Parliament
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Edith
authors.initials: E
authors.lastname: Pituskin
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: B Gino
authors.initials: BG
authors.lastname: Fallone
authors.affiliation: Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada.
authors.forename: Nawaid
authors.initials: N
authors.lastname: Usmani
keywords: Active surveillance; Indolent disease; Magnetic resonance imaging; Prostate cancer; Treatment triaging