STOCKHOLM, SWEDEN (UroToday.com) - Active surveillance (AS) is a viable management option for select men with prostate cancer (PC). AS can be used to delay or avoid radical treatment and the associated side effects. Dr. C. D. Tait and colleagues evaluated multiparametric MR imaging (mp-MRI) and MR guided biopsy (MRGB) for men with prostate cancer within the Prostate Cancer Research International Active Surveillance (PRIAS) study. Specifically, they compared the role of repeat mp-MRI and MRGB versus repeat TRUS guided prostate needle biopsy (PNB). A total of 111 patients from 4 centers were included in the study. AS inclusion criteria included PSA ≤ 10 ng/ml, PSA density < 0,2 ng/ml/ml, clinical stage ≤ cT2, Gleason score ≤ 6, and ≤ 2 positive biopsy cores.
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Following diagnosis, patients underwent mp-MRI and MRGB within 3 months of diagnosis and again at one year of follow-up. TRUS PNBx was also performed at one year. Patients were considered “reclassified” if TRUS PNBx revealed more than 2 positive cores, Gleason > 6 disease, presence of prostate cancer in ≥ 3 separate cancer foci upon both MRGB and TRUS PNBx, or suspicion of T3 tumor on mp-MRI. Combined repeat mp-MRI and MRGB were compared to TRUS PNBx. Twenty-three percent of patients were initially reclassified following mp-MRI and MRGB. At one year follow-up, 39% of patients were reclassified and advised to undergo definitive treatment. Reclassification at one year was due to both TRUS PNBx and MRGB, TRUS PNBx alone, and mp-MRI or MRGB results in 36%, 45%, and 18%, respectively. When combined with standard repeat TRUS PNBx, repeat mp-MRI and MRGB at one year led to an additional reclassification of 7% of patients.
Performance of mp-MRI and MRGB after one year of follow-up may provide additional value to AS protocols, as 7% of patients will experience reclassification.
Presented by C. D. Tait at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
Salford Royal NHS Foundation Trust, Department of Urology, Salford, UK
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com