Repeated MRIs during Active Surveillance: natural history of prostatic lesions and upgrading rates.

To test upgrading rates in patients on Active Surveillance (AS) for prostate cancer (PCa) after serial multiparametric magnetic resonance imaging (mpMRI) scans.

Retrospective analysis of 558 patients. Five different criteria of mpMRI progression were used: 1) PI-RADS score increase;2) lesion size increase;3) EPE score increase;4) overall mpMRI progression;5) number of criteria for mpMRI progression (0 vs. 1 vs. 2-3). Moreover, two definitions of PCa upgrading were evaluated:1) ISUP GG≥2 with >10% of pattern 4;2) ISUP GG ≥ 3. The estimated annual percent changes (EAPC) methodology depicted temporal trends of mpMRI progression criteria. Sensitivity, specificity, positive predictive (PPV) and negative predictive value (NPV) of mpMRI progression criteria were analysed. Multivariable logistic regression models tested PCa upgrading rates.

Lower rates over time of all mpMRI progression criteria were observed. The NPV of serial mpMRIs spans from 90.5 to 93.5% (ISUP GG≥2 with >10% of pattern 4 PCa upgrading) and from 98 to 99% (ISUP GG≥3 PCa upgrading), according to the different mpMRI progression criteria. A PSA-D cut-off of 0.15 ng/ml/ml sub stratified those patients who could skip a prostate biopsy. In multivariable logistic regression models testing PCa upgrading rates, all five mentioned mpMRI progression criteria achieved independent predictor status.

During AS, approximately 27% of patients experience mpMRI progression at first repeated scan. However, the rates of mpMRI progression decrease over time at subsequent mpMRIs. Patients with stable mpMRI findings and with PSA-D<0.15 ng/ml/ml could safely skip surveillance biopsies. Conversely, patients who experience mpMRI progression should undergo a prostate biopsy.

BJU international. 2021 Oct 22 [Epub ahead of print]

Stefano Luzzago, Mattia Luca Piccinelli, Francesco A Mistretta, Roberto Bianchi, Gabriele Cozzi, Ettore di Trapani, Antonio Cioffi, Michele Catellani, Matteo Fontana, Letizia Maria Ippolita Jannello, Francesco Maria Gerardo Botticelli, Giulia Marvaso, Sarah Alessi, Paola Pricolo, Matteo Ferro, Deliu-Victor Matei, Barbara A Jereczek-Fossa, Nicola Fusco, Giuseppe Petralia, Ottavio de Cobelli, Gennaro Musi

Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy., Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy., Division of Radiology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy., Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy.

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