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Prognostic Value of a Negative mpMRI during Active Surveillance for Prostate Cancer
Lampros Pantazis, MD, Hersh H. Bendre, MD, Rajveer Kaur, BSc, Aileen J. Feng, BA, Alexandra Hunter, BA, Neel Patel, MBBS, MPH, Rory L. Cochran, MD, PhD, Mukesh Harisinghani, MD, 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:Decreasing surveillance intensity for patients with negative multiparametric MRI (mpMRI) has been proposed, however, data on the detection performance and association of serial mpMRI with progression to clinically significant prostate cancer (csPCa) are limited.
METHODS:We identified patients in our institutional Active Surveillance (AS) database with grade group (GG) 1 PCa, baseline mpMRI within 6 months of diagnosis, and at least 1 additional biopsy and mpMRI. Positive mpMRI was defined as PI-RADS≥3 and csPCa defined as GG≥2. Performance metrics for csPCa detection were estimated per follow-up mpMRI with a unique biopsy within 6 months. Biopsy PCa grade progression-free survival was analyzed in the negative and positive baseline mpMRI subgroups with Cox regression models.
RESULTS:371 patients were identified with a median follow-up of 4.6 (IQR:2.9-6.7) years. 111 had a negative baseline mpMRI. Among 381 follow-up mpMRIs, sensitivity and NPV for csPCa on biopsy were 91.7% (95%CI:85.4-95.4) and 88.4% (79.9-93.6). In the negative baseline mpMRI subgroup 31% progressed to csPCa, and sensitivity and NPV of subsequent mpMRIs were 85.2% (67.5-94.1) and 90.2% (77.5-96.1). mpMRI progression (58%) was significantly associated with increased risk of biopsy progression (HR:4.25, 95%CI:2-9.1, p<0.001). 41.5% of patients with a positive baseline mpMRI progressed to csPCa while a subsequent negative mpMRI was not associated with a reduced risk of progression (HR:0.9, 95%CI:0.44-1.8, p=0.77).
CONCLUSIONS:Surveillance mpMRI has good sensitivity and NPV for detecting progression to csPCa, however, approximately 12% with a negative mpMRI will still have csPCa on systematic biopsy. Negative surveillance mpMRI is associated with reduced progression risk only in patients with a negative baseline mpMRI. These findings support serial mpMRI during AS, though not the omission of periodic biopsy based on MRI findings.
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