Publications & Research

MRI Identifies Candidates for Prostate Cancer Surveillance

In a retrospective study of 388 men believed to have low-risk prostate cancer, tumors that were clearly visualized on an initial MRI were significantly more likely to be upgraded or upstaged on later confirmatory biopsy, and to prompt prostatectomy at that time. In contrast, tumors that could not be clearly visualized on MRI at the initial evaluation were significantly more likely to remain low grade on later confirmatory biopsy, and lent themselves to active surveillance rather than surgery, said Dr. Hebert Alberto Vargas of the department of radiology, Memorial Sloan-Kettering Cancer Center, New York, and his associates.

“These results suggest that MRI of the prostate, if read by radiologists with appropriate training and experience, could help determine active surveillance eligibility and obviate the need for confirmatory biopsy in substantial numbers of patients,” they noted.

Initial biopsy samples of prostate cancers can miss areas of high-grade cancer, and “even the most stringent criteria misclassify 16%-42% of cases, which, despite low-risk features on initial biopsy, [are found to have] unfavorable pathological features at radical prostatectomy.” Accordingly, some treatment centers recommend a second, confirmatory biopsy before pursuing active surveillance, the investigators said.

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