Objective
To evaluate the integration of 3T nonendorectal coil multiparametric prostate magnetic
resonance imaging (mpMRI) at 2 high-volume practices that routinely use mpMRI in the
setting of active surveillance.
Materials and Methods
This was an institutional review board-approved, Health Insurance Portability and
Accountability Act-compliant, and dual-institution retrospective cohort study. Subjects
undergoing 3T mpMRI without endorectal coil at either study institution over a 13-month
period (August 1, 2015-August 31, 2016) were selected based on predefined criteria:
clinical T1/T2 Gleason 6 prostate cancer, prostate-specific antigen <15 ng/mL, ≥40
years old, mpMRI within 2 years of prostate biopsy, and Prostate Imaging Reporting
and Data System (PI-RADS) v2 score assigned. Subjects surveilled for Gleason ≥3 + 4
prostate cancer were excluded. The primary outcome was detection of Gleason ≥3 + 4
prostate cancer on magnetic resonance-ultrasound fusion biopsy, standard biopsy, or
prostatectomy within 6 months following mpMRI. Positive predictive values (PPVs) were
calculated.
Results
A total of 286 subjects (N = 193 from institution 1, N = 93 from institution 2) met
the criteria. Most (87% [90 of 104]) with maximum PI-RADS v2 scores of 1-2 did not
receive immediate biopsy or treatment and remained on active surveillance. Incidence
and PPVs for PI-RADS v2 scores of ≥3 were the following: PI-RADS 3 (n = 57 [20%],
PPV 21% [6 of 29]), PI-RADS 4 (n = 96 [34%], PPV 51% [39 of 77]), and PI-RADS 5 (n = 29
[13%], PPV 71% [20 of 28]). No Gleason ≥4 + 3 prostate cancer was identified for PI-RADS
v2 scores of 1-3 (0 of 43 with histology). Following mpMRI and subsequent biopsy,
21% (61 of 286) of subjects were removed from active surveillance and underwent definitive
therapy.
Conclusion
The 3T nonendorectal coil mpMRI has been integrated into the care of patients on active
surveillance and effectively stratifies risk of Gleason ≥3 + 4 prostate cancer in
this population.
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Article info
Publication history
Published online: April 10, 2018
Accepted:
February 17,
2018
Received:
December 11,
2017
Footnotes
Financial Disclosure: Matthew S. Davenport receives royalties from Wolters Kluwer. The remaining authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
