Role of Multiparametric Magnetic Resonance Imaging Prostate Specific Antigen Density and PI-RADS™ Score in Predicting Up Staging in Men on Active Surveillance. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Van Kuiken, Michelle; Blackwell, Robert H.; Bisanz, Bryan; Joyce, Cara; Yacoub, Joseph; Shea, Steven; Goldberg, Ari; Quek, Marcus L.; Flanigan, Robert C.; Gupta, Gopal N.
• Is Part Of: Urology practice. Volume 6:Issue 2(2019)
• Publication Date: 2019-03
• Subjects: magnetic resonance imaging -- watchful waiting -- prostatic neoplasms -- prostate-specific antigen -- neoplasm staging
• DOI: 10.1016/j.urpr.2018.05.007
• Languages: English
• ISSNs: 2352-0779

Abstract

Abstract: Introduction: Using a combination of magnetic resonance imaging of the prostate and prostate specific antigen density, we determined which men on active surveillance are at risk for up staging and which men could avoid repeat biopsy while remaining on surveillance. Methods: We reviewed the records of 110 men on active surveillance with Gleason 6 disease who underwent magnetic resonance imaging followed by UroNav fusion biopsy (Invivo, Gainesville, Florida). Using univariable and multivariable logistic regression analyses we examined the effect of age, race, prostate specific antigen, prostate specific antigen density, prostate volume, PI-RADS (Prostate Imaging Reporting and Data System) score, number and size of target lesions, and time on surveillance to determine the likelihood of up staging to Gleason 7 or greater disease. Results: A total of 33 cases (30%) were up staged. On multivariable analysis prostate specific antigen density and PI-RADS score were significant predictors of up staging with adjusted odds ratios of 3.97 for prostate specific antigen density of 0.16 or more (CI 1.31-12.00, p <0.05), 13.8 for a PI-RADS 4 lesion (CI 2.3-81.3, p <0.01) and 25 for a PI-RADS 5 lesion (CI 3.8-163.5, p <0.01). When cross-tabulating these factors, men with a PI-RADS score of 3 or greater with a prostate specific antigen density of 0.16 ng/ml/cc or more had a 61.2% chance of up staging. Conversely, in men with PI-RADS score 3 or less and prostate specific antigen density less than 0.15, no up staging was seen. Conclusions: A combination of PI-RADS score and prostate specific antigen density predicts patients at risk for up staging at surveillance biopsy. Conversely, this combination may help determine which men may safely forgo biopsy.