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Does mpMRI improve clinical criteria in selecting men with prostate cancer for active surveillance?

Publication ,  Journal Article
Tay, KJ; Gupta, RT; Holtz, J; Silverman, RK; Tsivian, E; Schulman, A; Moul, JW; Polascik, TJ
Published in: Prostate Cancer Prostatic Dis
September 2017

BACKGROUND: Active surveillance (AS) has excellent short to medium term outcomes in well-selected prostate cancer patients. Traditional biopsy-based selection criteria have been criticized for inaccurate determination of cancer grade and extent. We evaluated the incremental benefit of multiparametric magnetic resonance imaging (mpMRI) in patient selection using various AS criteria. METHODS: We retrospectively evaluated men who received mpMRI before radical prostatectomy between 2011 and 2014. Patients were classified as suitable for AS using four criteria: (1) Epstein, (2) National Comprehensive Cancer Network (NCCN) low-risk or (3) extended criteria (Gleason ⩽3+4, PSA ⩽15 ng/ml, clinical stage ⩽T2b) using clinical parameters. The incremental value of mpMRI was evaluated against the referent standard of surgical pathology in determining suitability for AS using sensitivity, specificity, likelihood ratios (LRs) and area under receiver operating curves (AUCs). RESULTS: We evaluated 208 men. Only one man fulfilled Epstein criteria (1) at pathology, who was neither identified using clinical criteria nor mpMRI. Using (2), clinical criteria had a sensitivity of 80%, specificity 75%, LR+ 3.3, LR- 0.3, AUC 0.78, while combined clinical-mpMRI criteria achieved a sensitivity of 80%, specificity 99.5% (P<0.01), LR+ 162, LR- 0.2 and AUC 0.90 (P<0.01 compared to clinical). Using (3), clinical criteria had a sensitivity of 74%, specificity 47%, LR+ 1.4, LR- 0.6, AUC 0.60, while combined clinical-mpMRI criteria achieved a sensitivity of 26% (P<0.01), specificity 97% (P<0.01), LR+ 8.3, LR- 0.8 and AUC 0.62 (P=0.85). CONCLUSIONS: Addition of mpMRI significantly improved selection of men for AS using NCCN low-risk criteria. For selecting men with limited prognostic grade group 2, mpMRI significantly improved specificity at the expense of sensitivity.

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Published In

Prostate Cancer Prostatic Dis

DOI

EISSN

1476-5608

Publication Date

September 2017

Volume

20

Issue

3

Start / End Page

323 / 327

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Quality Improvement
  • Prostatic Neoplasms
  • Prostatectomy
  • Neoplasm Grading
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Tay, K. J., Gupta, R. T., Holtz, J., Silverman, R. K., Tsivian, E., Schulman, A., … Polascik, T. J. (2017). Does mpMRI improve clinical criteria in selecting men with prostate cancer for active surveillance? Prostate Cancer Prostatic Dis, 20(3), 323–327. https://doi.org/10.1038/pcan.2017.20
Tay, K. J., R. T. Gupta, J. Holtz, R. K. Silverman, E. Tsivian, A. Schulman, J. W. Moul, and T. J. Polascik. “Does mpMRI improve clinical criteria in selecting men with prostate cancer for active surveillance?Prostate Cancer Prostatic Dis 20, no. 3 (September 2017): 323–27. https://doi.org/10.1038/pcan.2017.20.
Tay KJ, Gupta RT, Holtz J, Silverman RK, Tsivian E, Schulman A, et al. Does mpMRI improve clinical criteria in selecting men with prostate cancer for active surveillance? Prostate Cancer Prostatic Dis. 2017 Sep;20(3):323–7.
Tay, K. J., et al. “Does mpMRI improve clinical criteria in selecting men with prostate cancer for active surveillance?Prostate Cancer Prostatic Dis, vol. 20, no. 3, Sept. 2017, pp. 323–27. Pubmed, doi:10.1038/pcan.2017.20.
Tay KJ, Gupta RT, Holtz J, Silverman RK, Tsivian E, Schulman A, Moul JW, Polascik TJ. Does mpMRI improve clinical criteria in selecting men with prostate cancer for active surveillance? Prostate Cancer Prostatic Dis. 2017 Sep;20(3):323–327.

Published In

Prostate Cancer Prostatic Dis

DOI

EISSN

1476-5608

Publication Date

September 2017

Volume

20

Issue

3

Start / End Page

323 / 327

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Quality Improvement
  • Prostatic Neoplasms
  • Prostatectomy
  • Neoplasm Grading
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans