The following is a summary of “Annual mpMRI surveillance: PI-RADS upgrading and increasing trend correlated with patients who harbor clinically significant disease,” published in the February 2024 issue of Urology by Greenberg, et al.
Prostate cancer screening routinely identifies individuals with very low- or low-risk disease, as outlined by guidelines from the National Comprehensive Cancer Network. For such patients, active surveillance (AS) represents the preferred management strategy, characterized by periodic biopsies and prostate-specific antigen tests to monitor disease progression. However, the advent of multiparametric magnetic resonance imaging (mpMRI) introduces a promising adjunct to surveillance protocols, offering improved visualization and characterization of prostate lesions. In this prospective study, the researchers aimed to evaluate the efficacy of annual mpMRI in enhancing surveillance among AS patients, particularly focusing on the implications of radiologic upgrading and Prostate imaging reporting and Data System (PI-RADS) trends as indicators of clinically significant disease.
The cohort comprised 208 AS patients with a median follow-up of 5.03 years, each of whom had undergone at least two biopsies and one mpMRI. Initial stratification based on PI-RADS scores revealed intriguing insights, with patients harboring PI-RADS 3 and 5 lesions exhibiting comparable Gleason grade reclassification-free survival rates, whereas those with PI-RADS 4 lesions displayed a notably lower 5-year reclassification-free survival. This observation underscores the potential of mpMRI in refining risk stratification and guiding clinical decision-making among AS cohorts.
Moreover, their analysis delved deeper into a subset of 70 patients who underwent multiple mpMRIs, enabling a nuanced exploration of mpMRI trends over time. Notably, the study group observed a compelling association between increasing mpMRI scores and heightened risk of Gleason grade reclassification, highlighting the utility of serial mpMRI assessments in identifying disease progression and informing management strategies. Specifically, patients demonstrating up-trending mpMRI scores exhibited a substantial 35.4% difference in 5-year Gleason grade reclassification-free survival probability compared to their counterparts.
In conclusion, their study advocates for integrating annual mpMRI into AS protocols, offering a non-invasive yet comprehensive approach to disease surveillance. While the stable recapitulated disease may obviate the need for repeat biopsies following confirmatory sampling, patients with initial PI-RADS 4 lesions or those exhibiting up-trending mpMRI scores necessitate closer monitoring and consideration of additional interventions, ensuring timely detection and management of the clinically significant disease.
Source: sciencedirect.com/science/article/abs/pii/S107814392400005X