AUA 2017: Multiparametric MRI represents an added value but not a substitute of follow-up biopsies in patients on active surveillance for low-risk prostate cancer

Boston, MA ( This study sought to address the question of whether repeat biopsies on active surveillance could be omitted if the MRI findings are reassuring. 95 patients from an active surveillance cohort with ≤ 2 cores of gleason 6 and PSA <10 underwent MRI.

Findings from MRI were correlated with subsequent biopsies, and the rates of clinically significant prostate cancer (gleason 7 on biopsy or PIRADS ≥3) were compared. 40% had PIRADS ≤2 with 25% PIRADS 3, 25% PIRADS 4, and 7% PIRADS 5. 75 patients were subsequently biopsied, with gleason 7 identified in 20 (26%), of which 3 had PIRADS ≤2. Importantly, of the patients with PIRADS ≥3 lesions, most with gleason 7 were detected on targeted biopsies, with only 5 identified only on systematic and not targeted approach. Thus, the authors conclude that in this study, 3+5/75 (10.6%) of patients would have been missed under a routine MRI followed by targeted biopsy approach. Conversely, PIRADS ≥3 patients made up 72% of the cohort, and the gleason 7 rate in these patients was about 40%, meaning that 60% underwent a biopsy without clear benefit. While this is certainly less than current AS protocols with yearly biopsies, more work is needed to refine imaging interpretation and cutoffs for biopsy and treatment.

Presented by: Stefano Luzago, Milan Italy

Written by: Jed Ferguson, MD/PhD and Ashish Kamat, MD. MD Anderson Cancer Center, Department of Urology.

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA