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Comparative Study
. 2021 May;205(5):1352-1360.
doi: 10.1097/JU.0000000000001547. Epub 2020 Dec 24.

Magnetic Resonance Imaging-Targeted and Systematic Biopsy for Detection of Grade Progression in Patients on Active Surveillance for Prostate Cancer

Nitin K Yerram  1 , Lori Long  2 , Luke P O'Connor  1 , Alex Z Wang  1 , Michael Ahdoot  1 , Amir H Lebastchi  1 , Sandeep Gurram  1 , Johnathan Zeng  3 , Heather Chalfin  1 , Stephanie A Harmon  4 , Sherif Mehralivand  5 , Maria J Merino  6 , Howard L Parnes  6 , Peter L Choyke  5 , Joanna Shih  7 , Bradford J Wood  2 , Baris Turkbey  5 , Peter A Pinto  1
Affiliations
Comparative Study

Magnetic Resonance Imaging-Targeted and Systematic Biopsy for Detection of Grade Progression in Patients on Active Surveillance for Prostate Cancer

Nitin K Yerram et al. J Urol. 2021 May.

Abstract

Purpose: Active surveillance for patients with low and intermediate risk prostate cancers is becoming a more utilized option in recent years. However, the use of magnetic resonance imaging and imaging-targeted biopsy for monitoring grade progression has been poorly studied in this population. We aim to define the utility of magnetic resonance imaging-targeted biopsy and systematic biopsy in an active surveillance population.

Materials and methods: Between July 2007 and January 2020, patients with diagnosed prostate cancer who elected active surveillance were monitored with prostate magnetic resonance imaging, imaging-targeted biopsy and standard systematic biopsy. Patients were eligible for surveillance if diagnosed with any volume Gleason grade 1 disease and select Gleason grade 2 disease. Grade progression (Gleason grade 1 to ≥2 disease and Gleason grade 2 to ≥3 disease) for each biopsy modality was measured at 2 years, 4 years and 6+ years.

Results: In total, 369 patients had both magnetic resonance imaging-targeted and systematic biopsy and were surveilled for at least 1 year. At 2 years, systematic biopsy, magnetic resonance imaging-targeted biopsy and combined biopsy (systematic+imaging-targeted) detected grade progression in 44 patients (15.9%), 73 patients (26.4%) and 90 patients (32.5%), respectively. Magnetic resonance imaging-targeted biopsy detected more cancer grade progression compared to systematic biopsy in both the low and intermediate risk populations (p <0.001). Of all 90 grade progressions at the 2-year time point 46 (51.1%) were found by magnetic resonance imaging-targeted biopsy alone and missed by systematic biopsy.

Conclusions: Magnetic resonance imaging-targeted biopsy detected significantly more grade progressions in our active surveillance cohort compared to systematic biopsy at 2 years. Our results provide compelling evidence that prostate magnetic resonance imaging and imaging-targeted biopsy should be included in contemporary active surveillance protocols.

Keywords: multiparametric magnetic resonance imaging; prostatic neoplasms; watchful waiting.

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Conflict of interest statement

Financial interest and/or other relationship with NVIDIA and NIH (which has cooperative research and development agreements with Philips, Celsion Corp., Boston Scientific, Siemens and Exact Robotics, and MTA support with Exact Imaging, Canon Medical, QT Imaging and Angiodynamics).

Figures

Figure 1.
Figure 1.
Flow chart of patients included in our study
Figure 2.
Figure 2.
Gleason grade progression detection rates at active surveillance time points stratified by biopsy modality.
Figure 3.
Figure 3.
Threshold analysis of grade progression detection rates and prostate volume. Vertical green line indicates volume threshold at which systematic biopsy could be skipped if allowing for 2.2% grade progression to be missed. If only MRI-targeted biopsy was utilized for surveillance in patients with prostate volumes >64 cm3, 97.8% (88/90) of all grade progressions would still be detected and 36.8% of systematic biopsies would have been avoided.
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Filson CP. Filson CP. J Urol. 2021 May;205(5):1359. doi: 10.1097/JU.0000000000001547.02. Epub 2021 Mar 11. J Urol. 2021. PMID: 33705226 No abstract available.
  • Editorial Comment.
    Morash C. Morash C. J Urol. 2021 May;205(5):1358-1359. doi: 10.1097/JU.0000000000001547.01. Epub 2021 Mar 11. J Urol. 2021. PMID: 33705227 No abstract available.

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