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EAU 2018

EAU 2018: Prostate MRI Combined with PSA-Density May Reduce the Number of Follow-Up Targeted Biopsies in Men on Active Surveillance for Low-Risk Prostate Cancer

Copenhagen, Denmark (UroToday.com)  Prostate-specific antigen (PSA)-density is a predictor of Gleason score (GS) upgrading in men on active surveillance (AS) for low-risk prostate cancer (PCa). Prostate MRI may also predict GS upgrading, however, false positivity induces over-diagnosis. Prostate Imaging Reporting and Data System (PI-RADS) score with the combination of PSA-density could further improve selection of those men that are at risk of disease reclassification. The authors investigated the outcome of GS upgrading (GS ≥3+4 PCa) of the MRI ± targeted biopsy (TBx) strategy in men on AS stratified by overall PI-RADS score and PSA-density.

Men on AS received an MRI at baseline (3 months after diagnosis), at confirmatory biopsy or at surveillance biopsy. If indicated (PI-RADS suspicion score ≥3) men underwent TBx using MRI-TRUS fusion. The used prospective clinical database between 2014 and 2017 consisted of 331 men on AS with GS 3+3 PCa (median age 67 yr, interquartile range [IQR] 62-72; median PSA level 8.0 ng/ml, IQR 5.6-12).

Of the 331 men, 198 (60%) men had a suspicious lesion on MRI (PI-RADS ≥3). Any PCa was detected in 169/331 (51%) of all men and in 169/198 (85%) of the men with a suspicious lesion (Table 1A). A total of 82/331 (25%) men showed GS upgrading; a positive MRI showed in 82/198 (41%) men upgrading. PI-RADS score 3, 4 and 5 index lesions were in 30%, 36% and 66% positive for GS ≥3+4 PCa, respectively. Stratifying PI-RADS score to PSA-density, GS upgrading occurred only once in men with low PSA-density (<0.15) and PI-RADS 3 index lesion. However, in men with high PSA-density (≥0.15), 45% GS upgrading had occured (Table 1B). 

Based on a MRI ± TBx strategy 1/4 men with GS 3+3 PCa treated with AS show upgrading to GS ≥3+4. If the MRI showed a suspicious lesion, 2 in 5 (40%) men showed GS upgrading. Risk-stratification based on PI-RADS score and PSA-density may reduce the number of follow-up TBx in men on AS.


Presented by: Osses D, Erasmus University Medical Center, Dept. of Urology, Dept. Radiology and Nuclear Medicine, Rotterdam, Netherlands

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark