Back to 2025 Abstracts
Can Surveillance Biopsy be Omitted in Active Surveillance for mpMRI-Negative Prostate Cancer?
Lampros Pantazis, MD, Hersh H. Bendre, MD, Aileen J. Feng, BA, Alexandra Hunter, BA, Neel Patel, MBBS, MPH, Douglas M. Dahl, MD, Matthew Wszolek, MD, Jason Efstathiou, MD, DPhil, Keyan Salari, MD, PhD, Adam S. Feldman, MD, MPH.
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: Forgoing surveillance biopsies in patients on Active Surveillance (AS) with a negative multiparametric MRI (mpMRI) has been proposed, however data on serial mpMRI for detecting progression to clinically significant prostate cancer (csPCa) over time is limited.
METHODS: Under IRB approval, we identified patients in our institutional AS database with grade group (GG) 1 PCa, baseline mpMRI within 6 months of diagnosis, and at least 1 additional prostate biopsy and mpMRI. For each follow-up mpMRI with a unique biopsy occuring within 6 months of it, we estimated performance metrics for csPCa (GG ≥2) detection per mpMRI. Positive mpMRI was defined as PIRADS≥3. In the negative baseline mpMRI subgroup, we performed Kaplan Meier analysis of mpMRI progression-free survival (PFS) and biopsy csPCa PFS.
RESULTS: 371 patients met selection criteria with median follow-up of 4.6 (IQR: 2.9-6.7) years. Among 381 follow-up mpMRIs evaluated, csPCa progression was detected in 36% of patients with a sensitivity of 91.7% (95%CI: 85.3-95.4) and NPV of 88.4% (95%CI: 79.9-93.6). In patients with a negative baseline mpMRI, sensitivity and NPV were 85.2% (95%CI: 67.5-94.1) and 90.2% (95%CI: 77.5-96.1), respectively. 58% of patients with a negative baseline mpMRI had eventual mpMRI progression at a median time of 3.7 (IQR: 1.8-8.5) years, and 31% had biopsy progression (Figure).
CONCLUSIONS: In AS patients, surveillance mpMRI has good sensitivity and NPV for detecting progression to csPCa, however, approximately 12% with a negative mpMRI will still have csPCa. Notably, more than half of patients with negative baseline mpMRI will eventually develop a PIRADS≥3 lesion on follow-up mpMRIs. These data support continued surveillance imaging in those with negative baseline mpMRI and consideration of biopsy even when surveillance mpMRI is negative.
Back to 2025 Abstracts
