Utility of multiparametric magnetic resonance imaging in the risk stratification of men with Grade Group 1 prostate cancer on active surveillance

Mufaddal K. Mamawala, Alexa R. Meyer, Patricia K. Landis, Katarzyna J. Macura, Jonathan I. Epstein, Alan W. Partin, Ballentine H. Carter, Michael A. Gorin

Research output: Contribution to journalArticle


Objective: To assess if the adoption of multiparametric magnetic resonance imaging (mpMRI) in active surveillance (AS) has improved the identification of occult higher-grade prostate cancer (PCa). Patients and Methods: We retrospectively identified men from the Johns Hopkins AS registry enrolled since 2013 (year of mpMRI adoption) with Grade Group (GG) 1 PCa and who underwent a single mpMRI. Men in this group were dichotomised by the presence (n = 207) or absence (negative mpMRI, n = 225) of one or more lesions with a Prostate Imaging-Reporting and Data System (PI-RADS) score of ≥ 3. Both groups were compared to a third cohort of men with GG1 PCa enrolled in AS prior to 2013 (pre-mpMRI era, n = 669). The risk of upgrading to GG ≥ 2 PCa on follow-up biopsies (performed with or without MRI targeting) was evaluated among the groups using survival analysis. Results: Men in both mpMRI groups underwent a median (interquartile range [IQR]) of 2 (2–3) biopsies separated by a median (IQR) interval of 13 (12–16) months, whereas men in the pre-MRI era underwent a median (IQR) of 3 (2–5) biopsies, separated by a median (IQR) interval of 12 (12–14) months. The 2- and 4-year upgrade-free survival rates were 93% and 83%, 74% and 59%; and, 87% and 76% for the negative mpMRI, PI-RADS ≥ 3, and pre-mpMRI-era groups, respectively (P < 0.001). On multivariable analysis, both mpMRI groups had significantly different risk of upgrading compared to pre-mpMRI-era group (negative mpMRI group: hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39–0.95, P = 0.03; PI-RADS ≥ 3 group: HR 1.96, 95% CI 1.36–2.82, P < 0.001). Conclusions: mpMRI improves the risk stratification of men on AS and should be used to aid enrolment and monitoring decisions.

Original languageEnglish (US)
JournalBJU International
StateAccepted/In press - Jan 1 2020



  • #PCSM
  • #Prostate cancer
  • active surveillance
  • grade reclassification
  • mpMRI
  • targeted biopsy

ASJC Scopus subject areas

  • Urology

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