Korean J Radiol.  2021 Apr;22(4):559-567. 10.3348/kjr.2020.0852.

Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

• Salguero J
• Gómez-Gómez E
• Valero-Rosa J
• Carrasco-Valiente J
• Mesa J
• Martin C
• Campos-Hernández JP
• Rubio JM
• López D
• Requena MJ

• KMID: 2514621
• DOI: http://doi.org/10.3348/kjr.2020.0852

Abstract

Objective
To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS).
Materials and Methods
This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imagingreporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models.
Results
The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up.
Conclusion
Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

Keyword

Active surveillance; Prostate cancer; Multiparametric prostate magnetic resonance imaging; Confirmatory biopsy reclassification; Progression risk; Active treatment