Clinical Trials Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Apr 28, 2016; 8(4): 410-418
Published online Apr 28, 2016. doi: 10.4329/wjr.v8.i4.410
Role of serial multiparametric magnetic resonance imaging in prostate cancer active surveillance
Larissa J Vos, Michele Janoski, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani
Larissa J Vos, Keith Wachowicz, Atiyah Yahya, Oleksandr Boychak, John Amanie, Nadeem Pervez, Matthew B Parliament, Edith Pituskin, B Gino Fallone, Nawaid Usmani, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada
Michele Janoski, Department of Radiology and Diagnostic Imaging, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, T6G 1Z2, Canada
Author contributions: Usmani N designed the research; Janoski M, Wachowicz K, Yahya A, Boychak O, Amanie J, Pervez N, Parliament MB, Pituskin E, Fallone BG, and Usmani N performed the research; Amanie J, Pervez N, Parliament MB, and Usmani N contributed patients to the trial; Vos LJ, Janoski M, Wachowicz K, Yahya A, Boychak O, and Usmani N analyzed the data; Vos LJ, Janoski M, Wachowicz K, Yahya A and Usmani N wrote the paper.
Supported by The IGAR Initiative and the Clinical Trials Unit at the Cross Cancer Institute, which is supported in part by the Alberta Cancer Foundation.
Institutional review board statement: Research ethics approval was obtained from the local research ethics committee (Alberta Cancer Research Ethics Committee).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov. The registration identification number is NCT00676286 (https://clinicaltrials.gov/ct2/show/NCT00676286).
Informed consent statement: All eligible patients provided written informed consent prior to enrollment and participation in the trial.
Conflict-of-interest statement: None of the authors have any conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nawaid Usmani, MD, Assistant Professor, Department of Oncology, Cross Cancer Institute, University of Alberta, 11560 University Avenue NW, Edmonton, Alberta T6G 1Z2, Canada. nawaid.usmani@albertahealthservices.ca
Telephone: +1-780-4328518 Fax: +1-780-4328380
Received: August 28, 2015
Peer-review started: September 6, 2015
First decision: October 27, 2015
Revised: November 16, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: April 28, 2016
Processing time: 234 Days and 17.3 Hours
Abstract

AIM: To examine whether addition of 3T multiparametric magnetic resonance imaging (mpMRI) to an active surveillance protocol could detect aggressive or progressive prostate cancer.

METHODS: Twenty-three patients with low risk disease were enrolled on this active surveillance study, all of which had Gleason score 6 or less disease. All patients had clinical assessments, including digital rectal examination and prostate specific antigen (PSA) testing, every 6 mo with annual 3T mpMRI scans with gadolinium contrast and minimum sextant prostate biopsies. The MRI images were anonymized of patient identifiers and clinical information and each scan underwent radiological review without the other results known. Descriptive statistics for demographics and follow-up as well as the sensitivity and specificity of mpMRI to identify prostate cancer and progressive disease were calculated.

RESULTS: During follow-up (median 24.8 mo) 11 of 23 patients with low-risk prostate cancer had disease progression and were taken off study to receive definitive treatment. Disease progression was identified through upstaging of Gleason score on subsequent biopsies for all 11 patients with only 2 patients also having a PSA doubling time of less than 2 years. All 23 patients had biopsy confirmed prostate cancer but only 10 had a positive index of suspicion on mpMRI scans at baseline (43.5% sensitivity). Aggressive disease prediction from baseline mpMRI scans had satisfactory specificity (81.8%) but low sensitivity (58.3%). Twenty-two patients had serial mpMRI scans and evidence of disease progression was seen for 3 patients all of whom had upstaging of Gleason score on biopsy (30% specificity and 100% sensitivity).

CONCLUSION: Addition of mpMRI imaging in active surveillance decision making may help in identifying aggressive disease amongst men with indolent prostate cancer earlier than traditional methods.

Keywords: Active surveillance; Treatment triaging; Magnetic resonance imaging; Indolent disease; Prostate cancer

Core tip: Multiparametric magnetic resonance imaging (mpMRI) has the potential to distinguish more aggressive prostate cancer even when indolent prostate cancer is the biopsy diagnosis. Addition of mpMRI to active surveillance protocols would benefit decision making.