PURPOSE: The objective of this study is to determine the natural history of pathologically benign multi-parametric MRI (mpMRI) cancer suspicious regions (CSR) following targeted biopsy.
MATERIALS AND METHODS: Between January 2012 and September 2014, 330 men underwent prostate mpMRI. 533 CSRs were identified and scored on a Likert scale of 1-5 based on suspicion for malignancy (5=highest suspicion level). Following mpMRI, all men underwent MRI-US fusion-targeted prostate biopsy using the Profuse software and ei-Nav|Artemis system and a computer-generate 12-core random biopsy. This study analyzes a cohort of 34 men with 51 CSRs with benign prostate biopsies who underwent repeat mpMRI and PSA testing at one year. Changes in greatest linear measurement (GLM), suspicion score (ss) and serum PSA were ascertained.
RESULTS: Over one year, both the ss distribution and mean GLM of the CSRs decreased significantly (p< 0.0001), while mean PSA did not significantly change (p=0.632). Overall, 2 (3.9%), 15 (29.4%) and 34 (66.7%) CSRs showed an increase, no change or decrease in ss, respectively. None (0%), 21 (42.0%) and 29 (58.0%) showed an increase (≥20%), no change or decrease (≥20%) in GLM, respectively. Of the two CSRs exhibiting increases in ss, neither showed a PSA increase ≥0.5 ng/mL.
CONCLUSIONS: Our study provides compelling evidence that few benign CSRs increase in ss and/or GLM within one year, independent of baseline ss. Therefore, routinely repeating the mpMRI at one year in men with pathologically benign CSRs should be discouraged since it is unlikely to influence management decisions.
Bryk DJ, Llukani E, Huang WC, Lepor H. Are you the author?
Department of Urology, Smilow Comprehensive Prostate Cancer Center, New York University School of Medicine.
Reference: J Urol. 2015 May 20. pii: S0022-5347(15)04072-0.