Prostate Cancer: Multi-Parametric Magnetic Resonance Imaging of the Prostate re- classifies patients eligible for Active Surveillance.

Publikation: KonferencebidragPosterForskningpeer review

Introduction and Objectives: Pathological examination of the extracted prostate after radical prostatectomy often reveals that trans-rectal ultrasound (TRUS) and TRUS-guided biopsy (TRUS-bx) underestimated the tumor’s true size and aggressiveness.
This clinical problem seems to defy a satisfactory solution to the dilemma of whether to enroll patients in active surveillance (AS) or to offer the patient active treatment. We present the preliminary results of an on-going trial in which we investigate if multi-parametric magnetic resonance imaging (mpMRI) of the prostate detects significant prostate cancer (PC) better than TRUS and TRUS-bx, and if we may in this way make selection of patients for active surveillance safer.
Materials and Methods: From November 2014 patients enrolled in an AS program at Aarhus University Hospital, Denmark, were offered an mpMRI 8 weeks after TRUS-bx. All patients were AS candidates according to national guidelines. The mpMRI consisted of one anatomic sequence (T2-weigthed, high resolution) and two functional sequences (a diffusion-weighted sequences with high b-values and a dynamic contrast enhanced sequence). All lesions detected on the mpMRI were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) classification. MRI-guided in-bore biopsies (MRGB) were performed on lesions with a score of 4 or 5.
Results: Up until now, 12 patients have been scanned. One patient was excluded due to severe claustrophobia. Of the 11 patients with sufficient quality scans, five PI-RADS 4 or 5 lesions were detected in 4 patients (two transition-zone lesions and three peripheral-zone lesions). MRGB pathology revealed that all 4 patients (36%, (95%CI: 8%; 64%)) had significant cancer according to University College London definition 2. Two patients had a Gleason score up-grade (Gleason score 7 (3+4) and 7 (4+3), respectively). In the other two cases, MRGB pathology revealed foci of Gleason score 6 (3+3) with 13.7 mm and 7.6 mm cancer core length, respectively.
Conclusion: Additional mpMRI in AS patients seems to re-classify a substantial number of patients eligible for active surveillance, where significant PC have escaped the initial TRUS and TRUS-bx diagnostic strategy.
OriginalsprogEngelsk
Udgivelsesår2015
StatusUdgivet - 2015

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