Magnetic resonance imaging for long-term active surveillance biopsy decision-making Journal Article
| Authors: | Leni, R.; Tin, A. L.; Liso, N.; Carlsson, S. V.; Akin, O.; Montorsi, F.; Briganti, A.; Eastham, J. A.; Vickers, A. J.; Ehdaie, B. |
| Article Title: | Magnetic resonance imaging for long-term active surveillance biopsy decision-making |
| Abstract: | Objectives: To evaluate whether long-term magnetic resonance imaging (MRI) findings, alone or in combination with prostate-specific antigen (PSA) density or the result of prior surveillance biopsies, could be used to omit biopsies occurring after patients have been on active surveillance (AS) for ≥5 years. Patients and Methods: Analysis of a single-institution AS cohort of patients with Grade Group (GG) 1 prostate cancer who underwent a scheduled 6-year MRI and biopsy. Multivariable logistic regression was used to test the association between the Prostate Imaging-Reporting and Data System (PI-RADS) score, PSA density, status of prior AS biopsy, and reclassification to GG ≥2. We then analysed how many GG ≥2 cancers would be missed if the 6-year biopsy was avoided based on significant predictors. Results: In all, 49 of 221 men (22%) were reclassified to GG ≥2. PSA density and PI-RADS scores 4–5 were significant predictors; a prior negative AS biopsy was inversely associated with GG ≥2. The risk of missing GG ≥2 if the 6-year biopsy is omitted in men with an unsuspicious MRI (PI-RADS 1–2) was 12% (95% confidence interval [CI] 5.3–19%). After testing combinations of MRI findings, PSA density, and the status of the prior biopsy, we found the lowest risk of GG ≥2 in patients with a prior negative biopsy and PSA density of <0.10 ng/mL/cc (5.3%, 95% CI 1.5–10%). Conclusions: An unsuspicious MRI at 6 years is not enough alone to omit the 6-year AS biopsy under current guidelines. Combining MRI findings, PSA density, and prior negative AS biopsies is a promising strategy to tailor surveillance intensity. Our findings should be replicated in larger cohorts prior to implementation in clinical practice. © 2025 BJU International. |
| Keywords: | prostate cancer; active surveillance; reclassification; multiparametric magnetic resonance imaging; surveillance biopsy |
| Journal Title: | BJU International |
| Volume: | 136 |
| Issue: | 3 |
| ISSN: | 1464-4096 |
| Publisher: | Wiley Blackwell |
| Publication status: | Published |
| Date Published: | 2025-09-01 |
| Online Publication Date: | 2025-05-29 |
| Start Page: | 500 |
| End Page: | 506 |
| Language: | English |
| DOI: | 10.1111/bju.16798 |
| PROVIDER: | scopus |
| PMCID: | PMC12350062 |
| PUBMED: | 40437977 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- Source: Scopus |
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