Impact of Multiparametric MRI and PSA Density on the Initial Indication or the Maintaining in Active Surveillance During Follow-Up in low-Risk Prostate Cancer

Clin Genitourin Cancer. 2022 Jun;20(3):e244-e252. doi: 10.1016/j.clgc.2022.01.015. Epub 2022 Jan 31.

Abstract

Introduction: A greater selection of candidates for active surveillance (AS) of prostate cancer (PCa) may decrease the rate of delayed treatment. We aimed to study: 1) the impact of MRI and PSA density (PSAd) at baseline on the final status, and 2) the impact of bio-clinical features during the follow-up on pursuing AS.

Materials and methods: This retrospective, monocentric study between June 2013 and July 2020, included 99 patients in AS (median follow-up: 19 months [18-92]). All MRI were reviewed by a single radiologist. Lost to follow-up were 17 patients and 6 patients chose treatment by themselves. Treatment was proposed in case of upgrading (≥ GG2) or increasing PCa volume.

Results: Impact of MRI and PSAd at baseline: Combining PSAd ≤ 0.15 and PIRADS ≤ 3, the probability to remain in AS was 72%. This rate reached 83% when PSAd ≤ 0.10 was associated to normal MRI. During follow-up: One hundred fifty-seven prostatic biopsies (PBx) were performed and 38 (24%) found PCa upgrading. The association between negative MRI and PSAd ≤ 0.10, during follow-up, had an excellent NPV to predict treatment (95%). This combination concerned 25% (37/151) of surveillance biopsies that could have been avoided at the cost of delaying upgrading in 3% (1/37). In multivariate analysis, only PIRADS ≥ 4 before PBx was associated to a risk of treatment during follow-up (OR, 10.4 [95% CI, 4.2-25.8]; P < .0001).

Conclusion: Using PSAd and MRI at baseline to select patients showed excellent performances to predict the maintenance in AS. During follow-up, MRI PIRADS ≥ 4 was associated to an increased risk of treatment.

Keywords: PSA density; Prostatic biopsies; active surveillance; prostate cancer; prostatic MRI.

MeSH terms

  • Follow-Up Studies
  • Humans
  • Male
  • Multiparametric Magnetic Resonance Imaging*
  • Prostate-Specific Antigen
  • Prostatic Neoplasms* / diagnostic imaging
  • Prostatic Neoplasms* / pathology
  • Prostatic Neoplasms* / therapy
  • Retrospective Studies
  • Watchful Waiting

Substances

  • Prostate-Specific Antigen