Routine use of multiparametric magnetic resonance imaging (mpMRI) leads to earlier treatment of men on active surveillance (AS) for prostate cancer, investigators reported at the Canadian Urological Association’s 74th Annual Meeting in Quebec City.

Alice Yu, MD, and colleagues at Massachusetts General Hospital in Boston studied 1265 men who started AS at their institution from September 1996 to December 2016. They divided the cohort into pre- and post-MRI eras, using as the cutoff January 2014, when their institution incorporated routine use of mpMRI into its AS protocol. Previous research has shown that mpMRI improves detection of clinically significant prostate cancer.

All men in the post-MRI era group had at least 1 mpMRI performed compared with 55 (5.3%) of 1044 men in the pre-MRI era group. The groups did not differ with respect to PSA level or Gleason score. The mean time to follow-up was 3.0 years in the post-MRI era compared with 8.0 years in the pre-MRI era.

At 2 years, 21.8% of patients in the pre-MRI era received treatment compared with 15.7% in the pre-MRI era. Patients in the post-MRI era had a significantly shorter time to treatment than those in the pre-MRI era (1.5 vs 2.8 years). Among the treated patients, 288 underwent radical prostatectomy. Pathologic findings from the surgical specimen showed that 4.2%, 59.0%, and 36.8% of men in the pre-MRI era had Gleason score 8 or 9, Gleason score 7, and Gleason score 6 disease, respectively, compared with 0%, 75.0%, and 25.0% of men in the post-MRI era.

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Men in the pre- and post-MRI eras did not differ in pathologic T stage, N stage, and positive margin rates, according to the investigators.

“With widespread use of mpMRI, patients on AS are treated earlier,” Dr Yu’s team concluded in a study abstract. “However, further followup will be needed to see if this earlier identification and treatment of clinically significant disease ultimately results in a plateau in long-term treatment-free survival.”

Reference

Yu A, Baloda T, Nicaise E, et al. Widespread use of multiparametric MRI in an active surveillance cohort results in earlier identification and treatment of clinically significant prostate cancer. Presented at the Canadian Urological Association’s 74th Annual Meeting in Quebec City, June 29 to July 1. POD-3.4.

https://2019.cua.events/mobis/lecture/34