THE "NEW" PROSTATE CANCER INFOLINK

A newly published paper in the American Journal of Roetgenology provides an early data set on the application of 3 T multiparameric MRI scans in monitoring men on active surveillance (as opposed to the use of serial biopsies).

Habibian et al. report data from Winthrop University Hospital, in Mineola, NY, where they maintain a prospective database on > 200 men on active surveillance for low-risk forms of prostate cancer. The surveillance protocol at this institution uses annual 3 T mpMRIs in place of serial biopsies, such that biopsies are performed only when clinically necessary.

The current study was designed to report mpMRI characteristics of prostate cancer patients who discontinued active surveillance in this institution’s cohort of active surveillance patients after repeat imaging revealed possible evidence of tumor upgrading.

When this study was actually carried out, 114 patients on active surveillance had been given an initial, baseline mpMRI prior to the formal initiation of active surveillance and at least one follow-up mpMRI after active surveillance began.

Here are the data reported by Habibian et al.:

• For the 114 patients eligible for inclusion in this study, time on active surveillance ranged from 4 to 110 months.
• 14/114 patients (12.3 percent) discontinued active surveillance because changes on follow-up MRI suggested prostate cancer progression.
• The mpMRI data showed
  • An enlarged or more prominent lesion compared with the appearance on a previous MRI in 3/14 patients
  • A new lesion or lesions suspicious for cancer in 2/14 patients
  • Findings suspicious for or confirming extracapsular extension in 9/14 patients
• 7/14 patients had a biopsy after their follow-up mpMRI.
• Biopsy results led to tumor upgrading in 6/14 patients.
• All 14 patients received definitive treatment of some type for their localized prostate cancer.

The authors conclude that

The small number of patients with follow-up multiparametric MRI findings showing worsening disease supports the role of MRI in patients with early-stage prostate cancer. Multiparametric MRI is useful in monitoring patients on active surveillance and may identify patients with clinically significant cancer amenable to definitive treatment.

The decision to proceed to treatment based on MRI data alone in half the men who were perceived to have progressive prostate cancer in this study is obviously a clinical one that must be taken by a patient and his physician together. In the context of clinical practice (as opposed to a pre-designed research study), there is no absolute necessity for a repeat biopsy. The fact that the patient has prostate cancer has been previously determined.

These data once again help to confirm the potential role of mpMRI in monitoring patients on active surveillance as a method of limiting the need for serial biopsies. However, it would be inappropriate to conclude, at this time, that repeat biopsies are unnecessary in all patients unless there is clear MRI-based or other clinical evidence of the necessity for for a repeat biopsy. On the basis of the evidence available today, the need for and timing of repeat biopsies in each individual patient on active surveillance is clearly a “judgment call” that can only be made by that patient based on the recommendations of his physician, and it may be influenced by a range of factors (of which the MRI data is just one).

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment | Tagged: active, monitoring, mpMRI, MRI, multiparametric, surveillance |