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.