For men on prostate cancer active surveillance (AS), negative results on multiparametric magnetic resonance imaging (mpMRI) often predicts stable disease, according to investigators presenting at the American Urological Association’s 2022 annual meeting in New Orleans, Louisiana. Cases with high PSA density (PSAD) are an exception.
At the Cleveland Clinic AS program, 466 patients underwent a median of 4 prostate mpMRIs over 3.4 years; 120 (25.7%) had at least 1 surveillance mpMRI showing no distinct lesions in the prostate. Of these patients, 73 patients underwent a subsequent biopsy.
Among the 95 prostate biopsies performed in this group, 34.7% displayed tumors of equal-grade to the previous pathology and 49.5% showed lower-grade tumors, Jacob Enders, BS, a medical student at Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine in Ohio, reported. Only 10.5% of biopsies (in 9 of the 73 patients who underwent biopsy) showed upgrading to clinically significant prostate cancer of Gleason grade group 2 or higher.
In a multivariate logistic regression model, higher PSAD predicted upgrading to Gleason grade group 2 or higher prostate cancer at biopsy. Each 0.10 ng/mL/cc increment in PSAD was significantly associated with 4.2-fold increased odds of clinically significant prostate cancer, Enders reported.
“Patients with a negative mpMRI were more likely to be upgraded to [clinically significant prostate cancer] with increasing PSA density,” Enders and colleagues wrote in a study abstract. “Thus, patients with a negative mpMRI, especially in the setting of a low PSA density, may be able to defer biopsy given the low likelihood for disease upgrading.”
Enders J, Rothberg M, Kozel Z, et al. Negative prostate MRI as a predictor of disease stability in patients on active surveillance. Presented at: AUA 2022; May 13-16, 2022, New Orleans, Louisiana. Abstract MP43-07.