ROUTINE USE OF MAGNETIC RESONANCE IMAGING IN PROSTATE CANCER FACILITATES BETTER CANDIDATE SELECTION FOR ACTIVE SURVEILLANCE
Introduction and Objectives:
To evaluate the changing trends in appropriate candidate selection for Active Surveillance (AS) after routine use of Magnetic Resonance Imaging (MRI) for Prostate Cancer (PCa), using Transperineal Template guided Mapping Biopsy (TTMB)
Materials and Methods:
We retrospectively analyzed 462 TTMB performed at our institution (2008 – 2014) and identified 165 patients with low risk cancer eligible for AS based on TransRectal UltraSound (TRUS) biopsy (Prostate Specific Antigen (PSA) < 10 ng/ml, Gleason score (GS) ≤ 6, clinical stage ≤ T2a, unilateral disease and maximum of 1/3 positive cores and < 50% of total length) underwent TTMB. Routine use of MRI for PCa was started since 2012, hence the study population was divided into two groups G1 (Before MRI, 2008 – 2011) and G2 (After MRI, 2012 – 2014). We compared the TTMB results between two groups for the rates of GS upgrading (GS ≥ 7) and upstaging (bilateral) as compared to initial and detection of clinically significant caner (maximum cancer core length (MCCL) ≥ 4 mm and/or Gleason grade ≥ 3 + 4).
The clinical and biopsy characteristics of G1 and G2 are shown in table 1. MRI was performed in 82.1% patients in G2. TTMB detected cancer in G1 - 64 (65%) and G2 - 52 (77.6%) patients. The rates of upgrade and detection of clinically significant cancer was significantly in lower in G2 after routine use of MRI.
Routine use of MRI in PCa appears to aid in better candidate selection for active surveillance