The objective of this study was to test Prostate Imaging Reporting and Data System (PI-RADS) classification on multiparametric magnetic resonance imaging (mpMRI) and MRI-derived prostate-specific antigen density (PSAD) in predicting the risk of reclassification in men in active surveillance (AS), who underwent confirmatory or per-protocol follow-up biopsy.
Three hundred eighty-nine patients in AS underwent mpMRI before confirmatory or follow-up biopsy. Patients with negative (-) mpMRI underwent systematic random biopsy. Patients with positive (+) mpMRI underwent targeted fusion prostate biopsies + systematic random biopsies. Different PSAD cutoff values were tested (< 0.10, 0.10-0.20, ≥ 0.20). Multivariable analyses assessed the risk of reclassification, defined as clinically significant prostate cancer of grade group 2 or more, during follow-up according to PSAD, after adjusting for covariates.
One hundred twenty-seven (32.6%) patients had mpMRI(-); 72 (18.5%) had PI-RADS 3, 150 (38.6%) PI-RADS 4, and 40 (10.3%) PI-RADS 5 lesions. The rate of reclassification to grade group 2 PCa was 16%, 22%, 31%, and 39% for mpMRI(-) and PI-RADS 3, 4, and 5, respectively, in case of PSAD < 0.10 ng/mL2; 16%, 25%, 36%, and 44%, in case of PSAD 0.10 to 0.19 ng/mL2; and 25%, 42%, 55%, and 67% in case of PSAD ≥ 0.20 ng/mL2. PSAD ≥ 0.20 ng/mL2 (odds ratio [OR], 2.45; P = .007), PI-RADS 3 (OR, 2.47; P = .013), PI-RADS 4 (OR, 2.94; P < .001), and PI-RADS 5 (OR, 3.41; P = .004) were associated with a higher risk of reclassification.
PSAD ≥ 0.20 ng/mL2 may improve predictive accuracy of mpMRI results for reclassification of patients in AS, whereas PSAD < 0.10 ng/mL2 may help selection of patients at lower risk of harboring clinically significant prostate cancer. However, the risk of reclassification is not negligible at any PSAD cutoff value, also in the case of mpMRI(-).
Clinical genitourinary cancer. 2020 May 04 [Epub ahead of print]
Marco Roscigno, Armando Stabile, Giovanni Lughezzani, Pietro Pepe, Andrea Benedetto Galosi, Angelo Naselli, Richard Naspro, Maria Nicolai, Giovanni La Croce, Muhannad Aljoulani, Giovanna Perugini, Giorgio Guazzoni, Francesco Montorsi, Luca Balzarini, Sandro Sironi, Luigi Filippo Da Pozzo
Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy. Electronic address: ., Department of Urology and Division of Experimental Oncology, URI, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS-Clinical and Research Hospital, Rozzano, Italy., Urology Unit, Cannizzaro Hospital, Catania, Italy., Department of Urology, University Hospital "Ospedali Riuniti" and Polytechnic University of Marche Region, Ancona, Italy., Urology Department, Ospedale San Giuseppe, Gruppo Multimedica, Milan, Italy., Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy., Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy., Department of Urology, Istituto Clinico Humanitas IRCCS-Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Science, Humanitas University, Milan, Rozzano, Italy., Department of Radiology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy., Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy., Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy.