USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
BJU Int. 2021 Jun;127(6):712-721. doi: 10.1111/bju.15272. Epub 2020 Dec 10.
To investigate the utility of multiparametric magnetic resonance imaging (mpMRI) in the reassessment and monitoring of patients on active surveillance (AS) for Grade Group (GG) 1 prostate cancer (PCa).
We identified, from our prospectively maintained institutional review board-approved database, 181 consecutive men enrolled on AS for GG 1 PCa who underwent at least one surveillance mpMRI followed by MRI/prostate biopsy (PBx). A subset analysis was performed among 68 patients who underwent serial (at least two) mpMRI/PBx during AS. Pathological progression (PP) was defined as upgrade to GG ≥2 on follow up biopsy.
Baseline MRI was performed in 34 patients (19%). At a median follow-up of 2.2 years for the overall cohort, the PP was 12% (6/49) for Prostate Imaging Reporting and Data System (PI-RADS) 1-2 lesions and 37% (48/129) for the PI-RADS ≥3 lesions. The 2-year PP-free survival rate was 84%. Surveillance prostate-specific antigen density (P < 0.001) and surveillance PI-RADS ≥3 (P = 0.002) were independent predictors of PP on reassessment MRI/PBx. In the serial MRI cohort, the 2-year PP-free survival was 95% for the No-MRI-progression group vs 85% for the MRI-progression group (P = 0.02). MRI progression was significantly higher in the PP (62%) than in the No-PP (31%) group (P = 0.04). If serial MRI were used for PCa surveillance and biopsy were triggered based only on MRI progression, 63% of PBx might be postponed at the cost of missing 12% of GG ≥2 PCa in those with stable MRI. Conversely, this strategy would miss 38% of those with upgrading to GG ≥2 PCa on biopsy. Stable serial mpMRI correlates with no reclassification to GG ≥3 PCa during AS.
On surveillance mpMRI, PI-RADS ≥3 was associated with increased risk of PCa reclassification. Surveillance biopsy based only on MRI progression may avoid a large number of biopsies at the cost of missing many PCa reclassifications.
探讨多参数磁共振成像（mpMRI）在对分级分组（GG）1 前列腺癌（PCa）主动监测（AS）患者进行再评估和监测中的作用。
我们从我们前瞻性维护的机构审查委员会批准的数据库中确定了 181 名连续接受 AS 治疗的 GG1 PCa 患者，这些患者至少进行了一次监测性 mpMRI 检查，随后进行了 MRI/前列腺活检（PBx）。对 68 名在 AS 期间接受连续（至少两次）mpMRI/PBx 的患者进行了亚组分析。随访活检中发现升级为 GG≥2 为病理性进展（PP）。
在整个队列中，基线 MRI 检查在 34 名患者（19%）中进行。中位随访 2.2 年后，PI-RADS 1-2 病变的 PP 为 12%（6/49），PI-RADS≥3 病变的 PP 为 37%（48/129）。2 年无 PP 生存率为 84%。监测前列腺特异性抗原密度（PSA）（P<0.001）和监测 PI-RADS≥3（P=0.002）是再评估 MRI/PBx 时 PP 的独立预测因素。在连续 MRI 队列中，无 MRI 进展组 2 年无 PP 生存率为 95%，MRI 进展组为 85%（P=0.02）。PP 组 MRI 进展显著高于非 PP 组（62%比 31%，P=0.04）。如果仅根据 MRI 进展进行 PCa 监测并触发活检，那么在 MRI 稳定的情况下，63%的 PBx 可能会被推迟，代价是错过 12%的 GG≥2 PCa。相反，这种策略会错过 38%活检时升级为 GG≥2 PCa 的患者。稳定的连续 mpMRI 与 AS 期间无重新分类为 GG≥3 PCa 相关。
在监测性 mpMRI 中，PI-RADS≥3 与 PCa 再分类的风险增加相关。仅基于 MRI 进展进行监测性活检可能会避免大量活检，但代价是错过许多 PCa 再分类。
