Serial mpMRIs instead of serial biopsies for men on active surveillance

The role of baseline and repeat multiparametric MRI (mpMRI) scanning as a substitute for repeat biopsies in the initial evaluation and ongoing management of men on active surveillance continues to evolve.

A newly published paper by Habibian et al. reports data from the group at Winthrop University Hospital, in Mineola, NY. The paper is based on the management of their series of 200+ patients who have been being followed on active surveillance.

Here is the core information from this study:

  • 114/200 men in this program had both
    • An initial MRI prior to enrollment into the active surveillance program
    • At least one follow-up MRI after enrollment
  • 14/114 patients (12.3 percent) discontinued active surveillance based on initial follow-up MRI data suggestive of prostate cancer progression.
  • Among these patients with potentially progressive disease
    • The period of time on active surveillance ranged from 4 to 110 months
    • 3/14 or 21 percent exhibited signs of an enlarged or more prominent lesion on follow-up MRI.
    • 2/14 or 14 percent exhibited signs of a new lesion or lesions suspicious for cancer on follow-up MRI.
    • 9/14 or 64 percent exhibited findings suspicious for or confirming extracapsular extension on follow-up MRI.
    • 7/14  or 50 percent had a biopsy after follow-up multiparametric MRI.
    • Post-MRI biopsy results led to tumor upgrading in 6/14 or 43 percent of the patients.
    • All 14 patients elected to have, and received, definitive treatment.

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.

They also note that they are now using (and have for some time used) an active surveillance regimen in which serial, annual, multiparametric MRI scanning has replaced serial biopsies. Biopsies are performed at their institution only when clinically necessary.

5 Responses

  1. Unfortunately, this study does not tell us enough about the patients in that without also providing biopsy data on the men without an MRI change there is no way to assess how many men with progressive disease might have been missed by not doing a biopsy.

  2. Dear Gerry:

    I have only seen the abstract. I would assume that some of this information is provided in the full text of the paper.

  3. Thanks, but I think it that had they done biopsies, that data would have been definitely included in the abstract

  4. Does anyone know if a multiparametric (mp) MRI can be done without contrast, and if so, is it as reliable as with contrast? Need to know. Thanks.

  5. David:

    Yes. An mpMRI can be done without contrast, but I’d be very surprised if the results were as informative as when the mpMRI is done with contrast — but please understand that I am not a radiologist.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: