Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer Journal Article


Authors: Vargas, H. A.; Akin, O.; Afaq, A.; Goldman, D.; Zheng, J.; Moskowitz, C. S.; Shukla-Dave, A.; Eastham, J.; Scardino, P.; Hricak, H.
Article Title: Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer
Abstract: Purpose: A barrier to the acceptance of active surveillance for men with prostate cancer is the risk of underestimating the cancer burden on initial biopsy. We assessed the value of endorectal magnetic resonance imaging in predicting upgrading on confirmatory biopsy in men with low risk prostate cancer. Materials and Methods: A total of 388 consecutive men (mean age 60.6 years, range 33 to 89) with clinically low risk prostate cancer (initial biopsy Gleason score 6 or less, prostate specific antigen less than 10 ng/ml, clinical stage T2a or less) underwent endorectal magnetic resonance imaging before confirmatory biopsy. Three radiologists independently and retrospectively scored tumor visibility on endorectal magnetic resonance imaging using a 5-point scale (1 - definitely no tumor to 5 - definitely tumor). Inter-reader agreement was assessed with weighted kappa statistics. Associations between magnetic resonance imaging scores and confirmatory biopsy findings were evaluated using measures of diagnostic performance and multivariate logistic regression. Results: On confirmatory biopsy, Gleason score was upgraded in 79 of 388 (20%) patients. Magnetic resonance imaging scores of 2 or less had a high negative predictive value (0.96-1.0) and specificity (0.95-1.0) for upgrading on confirmatory biopsy. A magnetic resonance imaging score of 5 was highly sensitive for upgrading on confirmatory biopsy (0.87-0.98). At multivariate analysis patients with higher magnetic resonance imaging scores were more likely to have disease upgraded on confirmatory biopsy (odds ratio 2.16-3.97). Inter-reader agreement and diagnostic performance were higher for the more experienced readers (kappa 0.41-0.61, AUC 0.76-0.79) than for the least experienced reader (kappa 0.15-0.39, AUC 0.61-0.69). Magnetic resonance imaging performed similarly in predicting low risk and very low risk (Gleason score 6, less than 3 positive cores, less than 50% involvement in all cores) prostate cancer. Conclusions: Adding endorectal magnetic resonance imaging to the initial clinical evaluation of men with clinically low risk prostate cancer helps predict findings on confirmatory biopsy and assess eligibility for active surveillance. © 2012 American Urological Association Education and Research, Inc.
Keywords: adult; controlled study; human tissue; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; histopathology; area under the curve; cancer risk; cancer staging; nuclear magnetic resonance imaging; magnetic resonance imaging; diagnostic accuracy; prostate specific antigen; disease association; retrospective study; biopsy; risk assessment; prostate cancer; gleason score; prostatic neoplasms; watchful waiting; prostate biopsy; predictive value of tests; rating scale; cancer epidemiology; age distribution; predictive value; kappa statistics; diagnostic test accuracy study
Journal Title: Journal of Urology
Volume: 188
Issue: 5
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2012-11-01
Start Page: 1732
End Page: 1738
Language: English
DOI: 10.1016/j.juro.2012.07.024
PROVIDER: scopus
PUBMED: 23017866
PMCID: PMC5617124
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 2 November 2012" - "CODEN: JOURA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Junting Zheng
    133 Zheng
  2. Peter T Scardino
    621 Scardino
  3. Chaya S. Moskowitz
    173 Moskowitz
  4. Hedvig Hricak
    333 Hricak
  5. James Eastham
    427 Eastham
  6. Amita Dave
    80 Dave
  7. Oguz Akin
    179 Akin
  8. Asim Ahmed Afaq
    10 Afaq
  9. Debra Alyssa Goldman
    97 Goldman