Multiparametric MRI can identify prostate cancer patients who can benefit from active surveillance

This study examined whether an imaging method called a multiparametric magnetic resonance imaging (mpMRI) is a useful tool in determining whether prostate cancer patients are candidates for active surveillance. 

Prostate cancer (PC) is the most common cancer diagnosed in men. However, due to development of careful screening programs which include a thorough physical examination, prostate-specific antigen or PSA (a protein made by the prostate gland which rises in PC) blood testing and effective imaging techniques, PC can be diagnosed very early. On the other hand, this early diagnosis has led to possible overtreatment of the disease. Many men are undergoing active, radical treatments, such as surgery, radiotherapy or chemotherapy, which can have debilitating long-term side effects such as sexual, bladder or bowel problems. Many patients with early-stage PC would be candidates for active surveillance (AS), which means a careful monitoring of the disease progression, in order to avoid treatment until truly necessary. There are worries, though, that AS may miss aggressive tumors, or that PSA and other screening measures may not be fully accurate, and these fears can lead men to switch from AS to active treatments. 

An MRI is an imaging tool that uses a large magnet, sound waves and a computer to produce images of the organs and tissues in the body. There are multiple types of MRI tests, each measuring a different component of the body. A mpMRI combines several types of MRI tests to form a more complete picture of the body. Therefore, a mpMRI can give information on the structure, blood flow and the chemical makeup of the prostate and the size of the cancer, or whether the cancer has spread to any other organ. This study analyzed whether a mpMRI could help to determine the aggressiveness of PC and which patients are candidates for AS. 

This study followed 133 PC patients. All patients underwent a mpMRI before having surgery to remove their cancer along with the whole prostate gland (radical prostatectomy). Following surgery, a pathological examination was performed on the removed cancer. These pathological results were compared to the mpMRI findings, as well as to conventional PC staging systems, which take into account PSA levels and the Gleason score (a measure of the aggressiveness of a cancer based on the type of cells found in the cancer) to see which patients would have been candidates for AS. Based on the pathology results, 14 patients were candidates for AS. Overall accuracy for the mpMRI was 92%, versus 70%, 88% and 59% respectively for the three conventional staging systems used. 

In summary, mpMRI can be a useful tool, along with conventional screening methods, in determining a patient’s candidacy for AS rather than AT.

This study included a small number of participants. A larger trial is needed in order to confirm these results.

Discuss with your doctor what treatment plan would be the most beneficial in your situation.