PURPOSE: The current selection criteria for Active Surveillance (AS) based on systematic biopsy (SB) underestimate prostate cancer volume and grade.
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To investigate the role of additional MRI-targeted biopsy (TB) in reclassification of patients who are eligible for AS based on SB.
MATERIALS AND METHODS: Two-institutions study including 281 men with elevated PSA who met the following criteria a) all underwent prebiopsy-MRI, a 12-core transrectal SB, and 2 additional MRI-TB of lesions that were suspicious for cancer during the same sequence as SB b) all were eligible for AS based on SB results. The criteria for AS were PSA < 10 ng/ml, no Gleason grade 4/5, ≤ 5 mm involvement of any biopsy core, and ≤ 2 positive SB cores. The patient characteristics were compared between reclassification and non-reclassification groups based on MRI-TB results.
RESULTS: Of the 281 patients, 58% had suspicious lesions on MRI. MRI-TB was positive for cancer in 50%(81/163). Overall, 10% (28/281) patients were reclassified by MRI-TB as not eligible for AS based on Gleason score (8), on cancer length (20) or both (9). Suspicious areas on MRI were located in the anterior part of the prostate in 54%(15/28). Patients who were reclassified had smaller prostate volume (37 vs. 52 cc) and were older (66.5 vs. 63 years) than those who were not reclassified (p< 0.05).
CONCLUSION: MRI-TB reclassified 10% of patients who were eligible for AS based on SB. Its incorporation into the AS eligibility criteria may reduce the risk of reclassification into higher stages during follow-up.
Ouzzane A, Renard-Penna R, Marliere F, Mozer P, Olivier J, Barkatz J, Puech P, Villers A. Are you the author?
Department of Urology, CHU Lille, Université de Lille, F-59000 Lille, France; Inserm U1189 - ONCO-THAI, CHRU Lille, Université de Lille, F-59120 Loos, France; Department of Radiology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France; Inserm U1189 - ONCO-THAI, CHRU Lille, Université de Lille, F-59120 Loos, France; Department of Radiology, CHU Lille, Université de Lille, F-59000 Lille, France.
Reference: J Urol. 2015 Mar 4. pii: S0022-5347(15)03265-6.