Abstract

We investigated the ability of prostate MRI to detect Gleason Grade Group (GG) =2 cancer in a standardized, multi-institutional active surveillance cohort.We evaluated men enrolled in Canary Prostate Active Surveillance Study (PASS) with GG<2 and who underwent a biopsy within 12 months of a multiparametric MRI. Our primary outcome was biopsy reclassification to GG2 or greater. We evaluated the performance of MRI PIRADS score and clinical factors. Multivariable logistic regression models were fit with MRI and clinical factors and used to perform receiver operating curve analyses.There were 361 participants with 395 prostate MRIs with a median follow-up of 4.1 (IQR: 2.0-7.6) years. Overall, 108/395 (27%) biopsies showed reclassification. Defining positive MRI as PIRADS 3-5, the NPV and PPV for detecting GG =2 cancer was 83% (95% CI: 76-90%) and 31% (95% CI: 26-37%), respectively. PIRADS was significantly associated with reclassification (PIRADS 5 versus 1 and 2: OR = 2.71; 95% CI: 1.21-6.17, p = 0.016) in a multivariable model but did not improve upon a model with only clinical factors (AUC 0.768 versus 0.762). In 194 fusion biopsies, higher grade cancer was found in targeted cores in 21 (11%) instances, while 25 (13%) had higher grade cancer found in the systematic cores.This study adds the largest cohort data to the body of literature for MRI in active surveillance, recommending systematic biopsy in patients with a negative MRI and the inclusion of systematic biopsy in patients with a positive MRI.

View details for DOI 10.1097/JU.0000000000001088

View details for PubMedID 32343189