They identified prostate cancer patients who had a 21-core biopsy and fulfilled the criteria for AS; PSA <10 ng/ml, stage T1–T2a disease, Gleason score <6, <3 positive cores, tumor length per core <3mm. 96 patients who underwent radical prostatectomy (RP) and a prostate MRI before surgery were studied. The main endpoint of the study was unfavorable pathology at RP, with or without the use of MRI as an AS inclusion criterion.
Mean age was 62.4 years and mean PSA was 6.1ng/ml. Prostate cancer was stage pT3 in 17.7% of cases. The rate of unfavorable pathology (pT3-4 and/or Gleason score 4+3) was 24.0%. A T3 disease on MRI was noted in 28 men (29.2%). The MRI was not a significant predictor of pT3 disease in RP specimens, rate of unfavorable disease, positive surgical margins, or Gleason upgrading. In a logistic regression model, no preoperative parameter was an independent predictor of unfavorable disease in the RP specimen. After a mean follow-up of 29 months, the recurrence-free survival was statistically equivalent between men with T3 on MRI and those with T1-T2 disease. They concluded that when the selection of patients for AS is based on an extended 21-core biopsy scheme with the cited inclusion criteria, the addition of MRI does not improve the prediction of high-risk and/or non organ-confined disease in radical prostatectomy specimens.
Presented by Guillaume Ploussard, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria