Complementing the active surveillance criteria with multiparametric magnetic resonance imaging.
Investig Clin Urol
; 61(6): 573-581, 2020 11.
Article
em En
| MEDLINE
| ID: mdl-33135402
ABSTRACT
PURPOSE:
To evaluate the usefulness of multiparametric magnetic resonance imaging (mpMRI) to avoid misclassification of patients with clinically significant prostate cancer (PCa) into active surveillance (AS). MATERIALS ANDMETHODS:
Patients with Gleason grade group (GG) 1 PCa on systematic biopsy who underwent mpMRI before radical prostatectomy (RP) were included. mpMRI and pathologic results were compared between the AS and NOT-AS candidates. Unfavorable disease was defined as the identification of T3-4 disease or GG upgrade in the RP specimen. We established an ideal cutoff Prostate Imaging Reporting and Data System (PI-RADS) score for predicting unfavorable disease, and analyzed the location of index lesions on mpMRI.RESULTS:
PI-RADS scores were not significantly different between AS candidates (n=64) and NOT-AS candidates (n=136; p=0.629). Among 64 AS candidates, GG upgrading and unfavorable disease were diagnosed after RP in 24 (37.5%) and 25 (39.1%) patients, respectively. The rate of unfavorable disease was greater for patients with a PI-RADS score of 5 (83.3%) than in those with a score ≤4 (34.5%; p=0.030). Moreover, most PI-RADS 5 lesions in AS candidates were located in the anterior half of the prostate, with GG upgrading on targeted biopsy in 75.0% of cases.CONCLUSIONS:
Among the patients with GG 1 PCa, PI-RADS scores did not differ significantly between AS and NOT-AS candidates. Nonetheless, AS candidates with PI-RADS 5 lesions were diagnosed with unfavorable disease in >80% of RP specimens. Significant cancer located in the anterior half of the prostate including the transitional zone can be missed by systematic biopsy.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Próstata
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Conduta Expectante
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Imageamento por Ressonância Magnética Multiparamétrica
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Aged
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article