Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance

  • Joseba Salguero (Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Enrique Gomez-Gomez (Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Jose Valero-Rosa (Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Julia Carrasco-Valiente (Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Juan Mesa (Department of Radiology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Cristina Martin (Department of Radiology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Juan Pablo Campos-Hernandez (Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Juan Manuel Rubio (Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Daniel Lopez (Department of Radiology, Reina Sofía University Hospital, IMIBIC, Cordoba University) ;
  • Maria Jose Requena (Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University)
  • Received : 2020.07.02
  • Accepted : 2020.09.21
  • Published : 2021.04.01
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Abstract

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

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References

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