Serial MRI in Active Surveillance of Prostate Cancer: Incremental Value.

To assess whether changes in serial multiparametric magnetic resonance imaging (mpMRI) can help predict pathological progression (PP) of prostate cancer (PCa) among men in active surveillance (AS).

Retrospective cohort study of 49 consecutive men with Gleason 6 PCa, who underwent mpMRI at baseline and again > six months later, each followed by a targeted prostate biopsy, between January 2011 and May 2015.

We evaluated whether progression on mpMRI (increase in index lesion suspicion score, increase in index lesion volume, or decrease in index lesion apparent diffusion coefficient, ADC) could predict PP (Gleason > 3 + 4 on subsequent biopsy, in either systematic or targeted cores). Diagnostic performance of mpMRI was determined with and without clinical data using a binary logistic regression model.

Mean interval between baseline and follow-up mpMRI was 28. 3 months (range: 11-43 months). PP occurred in 19 patients (39%). Sensitivity, specificity, PPV, and NPV of mpMRI were: 37%, 90%, 69%, and 70%, respectively. Area under the receiver operating characteristic curve (AUC) was 0. 63. A logistic regression model utilizing clinical information (either a maximum cancer core length > 3 mm on baseline biopsy or a prostate-specific antigen (PSA) density (PSAD) > 0. 15 at follow-up biopsy) had an AUC of 0. 87 for predicting PP. Addition of serial mpMRI data significantly improved the AUC to 0. 91 (p = 0. 044).

Serial mpMRI adds incremental value to PSAD and baseline cancer core length for predicting Gleason 6 upgrade among men in active surveillance.

The Journal of urology. 2015 Dec 07 [Epub ahead of print]

Ely R Felker, Jason Wu, Shyam Natarajan, Daniel J Margolis, Steven S Raman, Jiaoti Huang, Fred Dorey, Leonard S Marks

Ronald Reagan-UCLA Medical Center, Department of Radiology, 757 Westwood Plaza Suite 1638, Los Angeles, CA 90095. , David Geffen School of Medicine, Department of Urology, UCLA Uberroth Building, Suite 3361, 10945 LeConte Avenue, Los Angeles, CA 90095. , David Geffen School of Medicine, Department of Urology, UCLA Uberroth Building, Suite 3361, 10945 LeConte Avenue, Los Angeles, CA 90095; Department of Bioengineering, University of California Los Angeles. , Ronald Reagan-UCLA Medical Center, Department of Radiology, 757 Westwood Plaza Suite 1638, Los Angeles, CA 90095. , Ronald Reagan-UCLA Medical Center, Department of Radiology, 757 Westwood Plaza Suite 1638, Los Angeles, CA 90095. , David Geffen School of Medicine, Department of Pathology, 10833 Le Conte Ave. , Suite 13-229 CHS, Los Angeles, CA 90095. , David Geffen School of Medicine, Department of Urology, UCLA Uberroth Building, Suite 3361, 10945 LeConte Avenue, Los Angeles, CA 90095. , David Geffen School of Medicine, Department of Urology, UCLA Uberroth Building, Suite 3361, 10945 LeConte Avenue, Los Angeles, CA 90095. 

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