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URL: https://dx.doi.org/10.17504/protocols.io.j5jcq4n

Authors: Juho Eineluoto, Petrus Järvinen, Anu Kenttämies, Tuomas Kilpeläinen, Hanna Vasarainen, Kevin Sandeman, Andrew Erickson, Tuomas Mirtti, Antti Rannikko

Summary: Introduction: This study was conducted to describe the repeat multiparametric MRI (mpMRI) changes occurring in prostate cancer (PCa) patients during active surveillance (AS), and to study possible associations between mpMRI-related parameters in predicting prostate biopsy (Bx) Gleason score (GS) upgrading >3+3 (GU) and protocol-based treatment change (TC). Materials and methods: The study cohort consisted of 76 AS patients with GS 3+3 PCa and at least two consecutive mpMRIs of the prostate performed between 2006 and 2015. Patients were followed according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol and additional mpMRIs. The primary end points were GS upgrading (GU) (>3+3) in protocol-based biopsies and protocol-based TC. Results: 53/76 (69%) patients had progression (PIRADS upgrade, size increase or new lesion[s]), 18/76 (24%) had radiologically stable disease, and 5/76 (7%) had regression (PIRADS or size decrease, disappearance of lesion[s]) in repeat mpMRIs during AS. PIRADS scores 4 to 5 in the initial mpMRI was associated with GU (p=0.008) and protocol-based TC (p=0.009). Tumour progression on repeat mpMRIs was associated with TC (p=0.045) but not with GU (p=1.00). PIRADS scores 4-5 predict GU (sensitivity 0.80 [95% confidence interval (CI); 0.51-0.95, specificity 0.62 [95% CI; 0.52-0.77]) with PPV and NPV values of 0.34 (95% CI; 0.21-0.55) and 0.93 (95% CI; 0.80-0.98), respectively. Conclusion: mpMRI is a useful tool not only to select but also to monitor PCa patients on AS.

Affiliations: Department of Urology, University of Helsinki and Helsinki University Hospital, Department of Urology, University of Helsinki and Helsinki University Hospital, Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Department of Urology, University of Helsinki and Helsinki University Hospital, Department of Urology, University of Helsinki and Helsinki University Hospital, Department of Pathology, University of Helsinki and Helsinki University Hospital, Finnish Institute of Molecular Medicine, University of Helsinki and Helsinki University Hospital, Department of Pathology, University of Helsinki and Helsinki University Hospital, Department of Urology, University of Helsinki and Helsinki University Hospital

Version: 1

Publication Date: 2017

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