MRI Can Help Determine Prostate Cancer Management

MR imaging of patients with prostate cancer can help physicians determine which patients are candidates for active surveillance of the disease, said researchers in a study published in the journal Radiology.

To help identify which patients with prostate cancer would be the most appropriate candidates for active surveillance, researchers from the National Institutes of Health examined the utility of multiparametric MRI and compared the results with conventional clinical assessment scoring systems.

A total of 133 patients (median age 59.3 years) participated in the study. The patients had a mean of prostate-specific antigen level of 6.73 ng/mL and underwent multiparametric MRI at 3.0 T before they underwent radical prostatectomy. The researchers then retrospectively classified the patients as to whether they would have met the active surveillance criteria. Current criteria for active surveillance were a dominant tumor smaller than 0.5 mL without Gleason 4 or 5 patterns or extracapsular or seminal vesicle invasion.

After determining each patient's classification, the researchers compared conventional clinical assessment scores (the D'Amico, Epstein, and CAPRA scoring systems) with the multiparametric MR imaging findings.

The researchers found that 14 patients would have been eligible for active surveillance on the basis of prostatectomy results. The conventional clinical assessments for predicting candidates for active surveillance and the MRI, for sensitivity, positive predictive value, and overall accuracy were, respectively:

• D'Amico system – 93 percent, 25 percent, and 70 percent

• Epstein criteria – 64 percent, 45 percent, and 88 percent

• CAPRA scoring system – 93 percent, 20 percent, and 59 percent

• Multiparametric MRI – 93 percent, 57 percent, and 92 percent

The researchers concluded that the multiparametric MRI provides a useful additional tool in helping physicians determine if a patient is a candidate for active surveillance or would benefit best from active treatment.