Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer

Authors

  • Lambros Stamatakis MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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    • The first two authors contributed equally to this article.

  • M. Minhaj Siddiqui MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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    • The first two authors contributed equally to this article.

  • Jeffrey W. Nix MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Jennifer Logan BS,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Soroush Rais-Bahrami MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Annerleim Walton-Diaz MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Anthony N. Hoang MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Srinivas Vourganti MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Hong Truong MS,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Brian Shuch MD,

    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Howard L. Parnes MD,

    1. Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
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  • Baris Turkbey MD,

    1. Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Peter L. Choyke MD,

    1. Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Bradford J. Wood MD,

    1. Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland
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  • Richard M. Simon DSc,

    1. Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Peter A. Pinto MD

    Corresponding author
    1. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    2. Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, Maryland
    • Corresponding author: Peter A. Pinto, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1210, Building 10 CRC Room 2W-5940, Bethesda, MD 20892-1210. Fax: (301) 402-0922; E-mail: pintop@mail.nih.gov.

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  • We thank Kelly Holliday and Georgia Shaw of the Urologic Oncology Branch, Center for Cancer Research, for assisting with the manuscript review and submission processes.

Abstract

BACKGROUND

Active surveillance (AS) is an attempt to avoid overtreatment of clinically insignificant prostate cancer (PCa); however, patient selection remains controversial. Multiparametric prostate magnetic resonance imaging (MP-MRI) may help better select AS candidates.

METHODS

We reviewed a cohort of men who underwent MP-MRI with MRI/Ultrasound fusion–guided prostate biopsy and selected potential AS patients at entry using Johns Hopkins criteria. MP-MRI findings were assessed, including number of lesions, dominant lesion diameter, total lesion volume, prostate volume, and lesion density (calculated as total lesion volume/prostate volume). Lesions were assigned a suspicion score for cancer by MRI. AS criteria were reapplied based on the confirmatory biopsy, and accuracy of MP-MRI in predicting AS candidacy was assessed. Logistic regression modeling and chi-square statistics were used to assess associations between MP-MRI interpretation and biopsy results.

RESULTS

Eighty-five patients qualified for AS with a mean age of 60.2 years and mean prostate-specific antigen level of 4.8 ng/mL. Of these, 25 patients (29%) were reclassified as not meeting AS criteria based on confirmatory biopsy. Number of lesions, lesion density, and highest MRI lesion suspicion were significantly associated with confirmatory biopsy AS reclassification. These MRI-based factors were combined to create a nomogram that generates a probability for confirmed AS candidacy.

CONCLUSION

As clinicians counsel patients with PCa, MP-MRI may contribute to the decision-making process when considering AS. Three MRI-based factors (number of lesions, lesion suspicion, and lesion density) were associated with confirmatory biopsy outcome and reclassification. A nomogram using these factors has promising predictive accuracy for which future validation is necessary. Cancer 2013;119:3359–66. Published 2013. This article is a U.S. Government work and is in the public domain in the USA

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