Considering this background, we aimed to demonstrate the impact of introducing MRI before the confirmatory prostate biopsy in two consecutive cohorts (with and without the use of MRI before the confirmatory biopsy) and to analyze its predictive value in the reclassification rate. Altogether, 170 male patients from a single tertiary-care academic institution who enrolled in an AS program between 2011 and 2019 were included in this study. The cohort was stratified into three different groups according to the use of MRI before a confirmatory biopsy and the presence of a suspicious MRI (PIRADS ≥ 3) (Fig 1).
Figure 1. Distribution of the reclassification pattern at confirmatory biopsy among the cohorts. mpMRI = multiparametric magnetic resonance imaging, PI-RADS = prostate imaging-reporting and data system
The study showed that the patients with a suspicious MRI have a higher chance of reclassification in comparison to patients with a non-suspicious MRI, or even to the patients without MRI before the confirmatory biopsy (Fig 1).
Next, a univariate logistic regression model was performed to determine the risk of reclassification at the confirmatory biopsy with the inclusion of MRI before it, showing a clear increase in the reclassification risk (odds ratio [OR]: 2.41) and particularly if a suspicious lesion were found on the MRI (OR: 5.44). Furthermore, in the multi-parametric analysis, the presence of suspicious findings on MRI (PIRADS score ≥ 3) (OR: 4.72) persisted showing a clear and statistical association with a higher risk of reclassification at the confirmatory biopsy in the cohort that underwent MRI.
When comparing the chance of progression during the follow up within the patients with MRI before biopsy reclassification, the results revealed that the patients with suspicious MRI were at greater risk for moving to an active treatment (Fig 2).
Figure 2. Probability of progression-free survival according to the results of MRI performed before the confirmatory biopsy.
Finally, when adjusting for main variables in the multi-parametric analysis, the presence of suspicious MRI remained associated with a higher risk of progression to active treatment during the follow-up (hazard ratio [HR]:2.62).
We can conclude that the inclusion of MRI before the confirmatory biopsy is a useful tool to stratify the risk of reclassification and that the presence of suspicious lesions on MRI could be also considered a putative prognostic factor for future reclassification/progression during the follow-up.
Written by: Joseba Salguero, MD, IMIBIC, Twitter: @josalse, and Enrique Gómez-Gómez, MD, FEBU, PhD, Twitter: @enriquegomezgo4, Department of Urology, University Hospital Reina Sofia, Cordoba, Spain
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