Multiparametric magnetic resonance imaging findings in men with low-risk prostate cancer followed using active surveillance

Jeffrey K. Mullins, David Bonekamp, Patricia Landis, Hosne Begum, Alan Wayne Partin, Jonathan Ira Epstein, H Ballentine Carter, Katarzyna Macura

Research output: Contribution to journalArticle

Abstract

Objective To assess the performance of multiparametric magnetic resonance imaging (MRI) in identifying pathological-index (path-index) lesions, defined as cancer present in the same prostate sextant in two separate surveillance biopsies, in men followed within an active surveillance (AS) programme for low-risk prostate cancer (CaP) with extended follow-up. Materials and Methods A total of 50 men, representing >215 person-years of follow-up in an AS programme, who were referred for prostate MRI were randomly chosen to have their images reviewed by a radiologist with expertise in prostate MRI, who was blinded to biopsy results. Index lesions on MRI were defined as a single suspicious lesion ≥10 mm or >2 lesions in a given prostate sextant. Lesions on MRI were considered suspicious if ≥2 abnormal parameters co-registered anatomically. Path-index lesions were defined as cancer present in a given prostate sextant on two separate biopsy sessions. Sensitivity and specificity were calculated to test the performance of MRI for identifying path-index lesions. Clinical and pathological features were compared between men with and without a MRI-index lesion. Results A total of 31 path-index and 13 MRI-index lesions were detected in 22 and 10 patients, respectively. Multiparametric MRI demonstrated excellent specificity and negative predictive value (0.974 and 0.897, respectively) for the detection of path-index lesions. Sensitivity (0.19) and positive predictive value (0.46) were considerably lower. Patients with an index lesion on MRI were younger and less likely to have met the 'Epstein' criteria for very low-risk CaP. Compared with men without an MRI lesion, a significant increase in biopsy reclassification was noted for men with a MRI lesion (40 vs 12.5%, P = 0.04). Conclusions A non-suspicious MRI was highly correlated with a lack of path-index lesions in an AS population. Multiparametric MRI may be useful in both the selection and monitoring of patients undergoing AS.

Original languageEnglish (US)
Pages (from-to)1037-1045
Number of pages9
JournalBJU International
Volume111
Issue number7
DOIs
StatePublished - Jun 2013

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Prostatic Neoplasms
Magnetic Resonance Imaging
Prostate
Biopsy
Population Surveillance
Physiologic Monitoring
Patient Selection
Neoplasms
Sensitivity and Specificity

Keywords

  • magnetic resonance imaging
  • prostate cancer
  • sensitivity and specificity
  • surveillance

ASJC Scopus subject areas

  • Urology

Cite this

Multiparametric magnetic resonance imaging findings in men with low-risk prostate cancer followed using active surveillance. / Mullins, Jeffrey K.; Bonekamp, David; Landis, Patricia; Begum, Hosne; Partin, Alan Wayne; Epstein, Jonathan Ira; Carter, H Ballentine; Macura, Katarzyna.

In: BJU International, Vol. 111, No. 7, 06.2013, p. 1037-1045.

Research output: Contribution to journalArticle

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abstract = "Objective To assess the performance of multiparametric magnetic resonance imaging (MRI) in identifying pathological-index (path-index) lesions, defined as cancer present in the same prostate sextant in two separate surveillance biopsies, in men followed within an active surveillance (AS) programme for low-risk prostate cancer (CaP) with extended follow-up. Materials and Methods A total of 50 men, representing >215 person-years of follow-up in an AS programme, who were referred for prostate MRI were randomly chosen to have their images reviewed by a radiologist with expertise in prostate MRI, who was blinded to biopsy results. Index lesions on MRI were defined as a single suspicious lesion ≥10 mm or >2 lesions in a given prostate sextant. Lesions on MRI were considered suspicious if ≥2 abnormal parameters co-registered anatomically. Path-index lesions were defined as cancer present in a given prostate sextant on two separate biopsy sessions. Sensitivity and specificity were calculated to test the performance of MRI for identifying path-index lesions. Clinical and pathological features were compared between men with and without a MRI-index lesion. Results A total of 31 path-index and 13 MRI-index lesions were detected in 22 and 10 patients, respectively. Multiparametric MRI demonstrated excellent specificity and negative predictive value (0.974 and 0.897, respectively) for the detection of path-index lesions. Sensitivity (0.19) and positive predictive value (0.46) were considerably lower. Patients with an index lesion on MRI were younger and less likely to have met the 'Epstein' criteria for very low-risk CaP. Compared with men without an MRI lesion, a significant increase in biopsy reclassification was noted for men with a MRI lesion (40 vs 12.5{\%}, P = 0.04). Conclusions A non-suspicious MRI was highly correlated with a lack of path-index lesions in an AS population. Multiparametric MRI may be useful in both the selection and monitoring of patients undergoing AS.",
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AU - Epstein, Jonathan Ira

AU - Carter, H Ballentine

AU - Macura, Katarzyna

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