New Orleans—After a median of 2 years in an active surveillance cohort being followed with multiparametric-magnetic resonance imaging (mpMRI) and MRI-transrectal ultrasound fusion-guided biopsy (“targeted biopsy”), rates of biopsy-proven pathologic progression are similar among men with low-risk and intermediate-risk disease, say researchers from the National Institutes of Health (NIH).
Analyses of data from this cohort also showed a significantly higher proportion of men with pathologic progression were identified by MRI than by other variables, and almost half of the men with pathologic progression were identified by targeted biopsy alone.
Results of the study were presented at the AUA annual meeting in New Orleans.
“The role of active surveillance for men with intermediate-risk prostate cancer is still being investigated. Recent studies and our data suggest that with better visualization afforded by MRI and better individual risk stratification using targeted biopsy, we may be able to safely survey some of these men,” said first author Thomas P. Frye, DO, clinical fellow in urologic oncology at the NIH, Bethesda, MD.
“In addition, our data indicate that MRI can improve prediction of patients who have pathologic progression, and with targeted biopsy, it could allow for a more accurate risk assessment of these men,” added Dr. Frye, who worked on the study with Peter A. Pinto, MD, and colleagues.
All men entered into the active surveillance program at the NIH undergo a confirmatory targeted biopsy. Men selected for the retrospective review presented by Dr. Frye had at least one follow-up mpMRI and targeted biopsy, Gleason ≤7 (≤3+4) disease, and no evidence of extracapsular extension or seminal vesicle invasion on mpMRI. They included 98 men with low-risk disease (Gleason ≤6) and 26 men with intermediate-risk disease (Gleason ≤3+4=7). The two risk groups were similar in mean age and mean PSA, and the intermediate-risk men had very-low-volume Gleason 7 disease, with the majority having just one or two positive cores.