Baseline Multiparametric MRI for Selection of Prostate Cancer Patients Suitable for Active Surveillance

Which Features Matter?

Francesco Sanguedolce, Giuseppe Petralia, Heminder Sokhi, Elena Tagliabue, Nicola Anyamene, Giles Hellawell, Anwar R Padhani

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Increasing evidence has supported the use of multiparametric magnetic resonance imaging (mpMRI) for the detection of prostate cancer. However, its role in selecting patients clinically suitable for active surveillance (AS) is still in development. We aimed to find relevant mpMRI features that might be helpful for refinement of the selection of low-risk prostate cancer patients for AS. We also evaluated the interobserver variability in reporting prostate mpMRI features.

PATIENTS AND METHODS: From 2008 to 2012, 135 patients were selected for AS using Epstein criteria. Baseline mpMRI studies were performed within 3 months of recruitment and reviewed by 2 radiologists who were unaware of the patients' outcomes. The radiologists recorded the mpMRI features using the Prostate Imaging Reporting and Data System (PI-RADS) guidelines. The overall likelihood of the presence of significant prostate cancer was also determined using the Likert and PI-RADS, version 2 (v2), scores. Univariate and multivariate analyses, receiver operating characteristic curves, and Kaplan-Meier survival curves were calculated for the mpMRI features with respect to patient withdrawal from the AS program and failure-free survival (FFS). The interobserver agreement was also evaluated.

RESULTS: At a median follow-up time of 31 months (range, 6-80 months), 84 patients (62.2%) were participating in the AS program. In 2 multivariate models, the variables significantly associated with outcomes for both readers were the index lesion size (hazard ratio [HR], 2.34 and 3.13, respectively) and overall PI-RADS, v2, score (HR, 2.51 and 3.21, respectively). The interobserver agreement was higher for the overall Likert and PI-RADS, v2, scores.

CONCLUSION: Overall, the PI-RADS, v2, score and index lesion size were strongly associated with FFS. Overall, the Likert and PI-RADS, v2, scoring systems have been confirmed to be useful, although further improvements are needed.

Original languageEnglish
Pages (from-to)155-163.e6
JournalClinical Genitourinary Cancer
Volume16
Issue number2
DOIs
Publication statusPublished - Apr 2018

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Prostate
Prostatic Neoplasms
Information Systems
Magnetic Resonance Imaging
Observer Variation
Survival
Kaplan-Meier Estimate
ROC Curve
Multivariate Analysis
Guidelines

Keywords

  • Aged
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging/methods
  • Male
  • Middle Aged
  • Observer Variation
  • Patient Selection
  • Prostatic Neoplasms/diagnostic imaging
  • ROC Curve
  • Sensitivity and Specificity
  • Watchful Waiting

Cite this

Baseline Multiparametric MRI for Selection of Prostate Cancer Patients Suitable for Active Surveillance : Which Features Matter? / Sanguedolce, Francesco; Petralia, Giuseppe; Sokhi, Heminder; Tagliabue, Elena; Anyamene, Nicola; Hellawell, Giles; Padhani, Anwar R.

In: Clinical Genitourinary Cancer, Vol. 16, No. 2, 04.2018, p. 155-163.e6.

Research output: Contribution to journalArticle

Sanguedolce, Francesco ; Petralia, Giuseppe ; Sokhi, Heminder ; Tagliabue, Elena ; Anyamene, Nicola ; Hellawell, Giles ; Padhani, Anwar R. / Baseline Multiparametric MRI for Selection of Prostate Cancer Patients Suitable for Active Surveillance : Which Features Matter?. In: Clinical Genitourinary Cancer. 2018 ; Vol. 16, No. 2. pp. 155-163.e6.
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AU - Sanguedolce, Francesco

AU - Petralia, Giuseppe

AU - Sokhi, Heminder

AU - Tagliabue, Elena

AU - Anyamene, Nicola

AU - Hellawell, Giles

AU - Padhani, Anwar R

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2018/4

Y1 - 2018/4

N2 - INTRODUCTION: Increasing evidence has supported the use of multiparametric magnetic resonance imaging (mpMRI) for the detection of prostate cancer. However, its role in selecting patients clinically suitable for active surveillance (AS) is still in development. We aimed to find relevant mpMRI features that might be helpful for refinement of the selection of low-risk prostate cancer patients for AS. We also evaluated the interobserver variability in reporting prostate mpMRI features.PATIENTS AND METHODS: From 2008 to 2012, 135 patients were selected for AS using Epstein criteria. Baseline mpMRI studies were performed within 3 months of recruitment and reviewed by 2 radiologists who were unaware of the patients' outcomes. The radiologists recorded the mpMRI features using the Prostate Imaging Reporting and Data System (PI-RADS) guidelines. The overall likelihood of the presence of significant prostate cancer was also determined using the Likert and PI-RADS, version 2 (v2), scores. Univariate and multivariate analyses, receiver operating characteristic curves, and Kaplan-Meier survival curves were calculated for the mpMRI features with respect to patient withdrawal from the AS program and failure-free survival (FFS). The interobserver agreement was also evaluated.RESULTS: At a median follow-up time of 31 months (range, 6-80 months), 84 patients (62.2%) were participating in the AS program. In 2 multivariate models, the variables significantly associated with outcomes for both readers were the index lesion size (hazard ratio [HR], 2.34 and 3.13, respectively) and overall PI-RADS, v2, score (HR, 2.51 and 3.21, respectively). The interobserver agreement was higher for the overall Likert and PI-RADS, v2, scores.CONCLUSION: Overall, the PI-RADS, v2, score and index lesion size were strongly associated with FFS. Overall, the Likert and PI-RADS, v2, scoring systems have been confirmed to be useful, although further improvements are needed.

AB - INTRODUCTION: Increasing evidence has supported the use of multiparametric magnetic resonance imaging (mpMRI) for the detection of prostate cancer. However, its role in selecting patients clinically suitable for active surveillance (AS) is still in development. We aimed to find relevant mpMRI features that might be helpful for refinement of the selection of low-risk prostate cancer patients for AS. We also evaluated the interobserver variability in reporting prostate mpMRI features.PATIENTS AND METHODS: From 2008 to 2012, 135 patients were selected for AS using Epstein criteria. Baseline mpMRI studies were performed within 3 months of recruitment and reviewed by 2 radiologists who were unaware of the patients' outcomes. The radiologists recorded the mpMRI features using the Prostate Imaging Reporting and Data System (PI-RADS) guidelines. The overall likelihood of the presence of significant prostate cancer was also determined using the Likert and PI-RADS, version 2 (v2), scores. Univariate and multivariate analyses, receiver operating characteristic curves, and Kaplan-Meier survival curves were calculated for the mpMRI features with respect to patient withdrawal from the AS program and failure-free survival (FFS). The interobserver agreement was also evaluated.RESULTS: At a median follow-up time of 31 months (range, 6-80 months), 84 patients (62.2%) were participating in the AS program. In 2 multivariate models, the variables significantly associated with outcomes for both readers were the index lesion size (hazard ratio [HR], 2.34 and 3.13, respectively) and overall PI-RADS, v2, score (HR, 2.51 and 3.21, respectively). The interobserver agreement was higher for the overall Likert and PI-RADS, v2, scores.CONCLUSION: Overall, the PI-RADS, v2, score and index lesion size were strongly associated with FFS. Overall, the Likert and PI-RADS, v2, scoring systems have been confirmed to be useful, although further improvements are needed.

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KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Middle Aged

KW - Observer Variation

KW - Patient Selection

KW - Prostatic Neoplasms/diagnostic imaging

KW - ROC Curve

KW - Sensitivity and Specificity

KW - Watchful Waiting

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DO - 10.1016/j.clgc.2017.10.020

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JO - Clinical Genitourinary Cancer

JF - Clinical Genitourinary Cancer

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