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Predictors of Upgrading between MR-Visible vs Invisible Gleason Grade Group 1 Prostate Cancer on Active Surveillance
Theodoros Karanikolas, BA1, Victoria Dai, BS2, Morgan Joseph, BS1, Stephen Reese, MD1, Kara Watts, MD1.
1Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, 2Albert Einstein College of Medicine, Bronx, NY, USA.
BACKGROUND: Magnetic resonance imaging (MRI)-visible prostate cancer (PCa) is associated with more aggressive disease compared to non-MR-visible disease. However, the association between MRI visibility and pathologic progression in Grade Group (GG) 1 disease remains poorly characterized.
METHODS: We retrospectively identified patients with newly diagnosed GG1 PCa who underwent pre-biopsy MRI and subsequent confirmatory biopsy on active surveillance (AS) protocol. Demographic, prostate-specific antigen density (PSAD), imaging, and pathologic data were abstracted. MR visibility was defined as cancer detected via targeted core or systematic core on the same side as an MRI-identified lesion. Outcomes included upgrading to clinically significant PCa (Grade Group ≥ 2) in any part of the prostate or ipsilateral to the PCa identified on initial biopsy. Multivariable logistic regression adjusted for PSAD and race/ethnicity was used to assess risk of upgrading.
RESULTS: Among 135 patients (75% Black or Hispanic/Latino; median age 64 years), 92 (68%) had MR-visible and 43 (32%) had MR-invisible GG1 on initial biopsy. Confirmatory biopsy upgrading occurred in 37 patients (27%); most (33/37) were ipsilateral. Compared to MR-visible GG1, MR-invisible GG1 demonstrated a higher rate of overall upgrade (40% vs 22%, p=0.039) and ipsilateral upgrade (35% vs 17%, p=0.030). On multivariable analysis, MR-visible status was associated with a lower likelihood of overall upgrading (OR 0.43, p=0.038) and a similar trend for ipsilateral upgrading (OR 0.46, p=0.065). PSAD was associated with ipsilateral upgrading (OR 1.57 per 0.1-unit increase, p=0.043).
CONCLUSIONS: In this diverse active surveillance cohort, MR-invisible GG1 PCa exhibited a higher risk of upgrading on confirmatory biopsy than MR-visible disease. Our early findings suggest GG1 can be managed appropriately with AS, even if MR-visible on initial biopsy.
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