Ces Urol 2017, 21(3):225-230 | DOI: 10.48095/cccu2017036

The role of multiparametric magnetic resonance imaging in active surveillance of prostate cancer

Šárka Kudláčková¹, Milan Král¹, Daniela Kurfürstová², František Záťura¹, František Hruška¹, Igor Hartmann¹, Vladimír Študent¹

¹ Urologická klinika LF UP a FN Olomouc

² Ústav klinické a molekulární patologie LF UP a FN Olomouc

Kudláčková Š, Král M, Kurfürstová D, Záťura F, Hruška F, Hartmann I, Študent V. The role of multiparametric magnetic resonance imaging in active surveillance of prostate cancer. The aim of the study: Evaluation of MRI biopsy results in active surveillance patients and evaluation of the benefit of MRI deployment in the AS protocol.

Methods: Sixty-nine patients meeting the Epstein criteria were enrolled in active surveillance since 2009. 30 patients underwent multiparameteric magnetic resonance of the prostate (mp-MRI) during follow-up. The structured scoring system PI-RADS v.2 was used for evaluation. Targeted biopsy of the lesion described as PIRADS score 4 or score 5 was performed. The incidence of carcinoma and the consistency between the lesions described as PIRADS score 4 and PIRADS score 5 and the positivity of the core was evaluated. If the Epstein criteria were not met then radical treatment was implemented. For the continuation of AS we did not allow even a minimal presence of GS 3+4 or a higher number of positive cores than 2. The change in the strategy towards radical treatment and evaluation of final preparations after radical robotic prostatectomy (RARP) was evaluated. We evaluated the upgrading and upstaging as well as the overall prognostic assessment.

Results: The average follow-up time was 3.37 (1-9) years. The mean age of the patient was 65.8 (55-74) years, the mean PSA was 6.08 (2.54-9.58) ng / ml, the mean prostate volume 59 (16-113) ml and an average density of 0.17 0.04-0.44). Carcinoma was confirmed by targeted biopsy in 19 patients (capture 63 %). The incidence of carcinoma in positive MRI with PIRADS 4 was 32 % and with PIRADS 5 76 %. 13 patients (43 %), based on the results of the targeted biopsy, terminated AS for non-compliance with AS protocol and proposed radical treatment (9 underwent RARP, 2 RARP in plan and 2 RT). Compared to the final results after RARP, upgrading occurred in 33 % of patients (3/9) and upstaging in 22 % of patients (2/9). In patients who underwent radical prostatectomy, favorable outcomes in 5 patients (55 %) and unfavorable outcomes in 4 patients (45 %) were achieved. All patients who underwent radical treatment are still in remission.

Conclusion: Incidence of high risk cancer in targeted biopsies was 43 %. This caused the termination of active surveillance and undergoing of radical therapy. Mp-MRI can help identify aggressive disease during active surveillance and thus increase the safety of this strategy for patients. For the use of MRI during AS, it will be necessary to define the significance of the radiological findings and also to define the radiological progression.

Keywords: Active surveillance, magnetic resonance imaging of prostate, prostate carcinoma, targeted biopsy.

Received: September 6, 2017; Accepted: September 30, 2017; Published: October 16, 2017