EAU 2017: 4th ESO Prostate Cancer Observatory: The Imaging Specialist’s Perspective on MRI
As Dr. Moore aptly pointed out, over the past year we have seen prostate MRI emerge as a possible triage test, increased utilization of targeted biopsies, incorporation of MRI into prognostic models, and utilization of prostate MRI in active surveillance (AS) algorithms. However, the challenges in 2017 include improving education and training, quality control, establishing infrastructure and delineating new models of care.
The PROMIS study1 was published earlier this year, enrolling 740 men of 576 underwent a 1.5T MRI + 5mm transperineal prostate mapping biopsy + 12 core transrectal-ultrasound guided (TRUS) biopsy. Among these patients, 71% had prostate cancer, of which 40% had clinically significant prostate cancer (Gleason grade group 3 or 6 mm of cancer). Importantly, MRI sensitivity was 93% compared to 48% for prostate cancer detection, suggesting that 27% of men could potentially avoid prostate biopsy and allow detection of 18% more clinically significant cancers if MRI were incorporated. When questioned from the audience regarding differences in endorectal coils, Dr. Moore noted that 1.5T is “more than adequate for prostate MRI in this setting”.
When incorporating MRI into prognostic models, Dr. Moore highlighted three important scenarios: (i) MRI adds to the ability to predict clinically significant prostate cancer when combined with other clinical parameters, (ii) 3T MRI prior to radical prostatectomy may predict biochemical recurrence and lymph node positive disease, and (iii) no visible lesion on MRI predicts poor outcomes of salvage radiotherapy after radical prostatectomy.
There are several important points with regards to the next 12 months for prostate MRI, specifically maturation of results from the multi-national PRECISION trial and improving on implementation challenges of using MRI as a triage test. We also eagerly await the results of the GAP3 study assessing MRI in 14,000 men on AS across North America, Europe and Australasia.
1. Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): A paired validating confirmatory study. Lancet 2017;389(10071):815-822.
Presented by: Caroline Moore, University College London, London, UK
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
Twitter: @zklaassen_md
at the #EAU17 -March 24-28, 2017- London, England