Magnetic Resonance Imaging at Second Surveillance Biopsy After Diagnosis in Patients With Grade Group 1 Prostate Cancer in the Canary Prostate Active Surveillance Study.

Abstract

No clear guidelines exist regarding MRI use after confirmatory biopsy during active surveillance. Our objective was to evaluate MRI performance after confirmatory biopsy in patients with vs without prior MRI-informed biopsy.

Patients in the Canary Prostate Active Surveillance Study with Gleason Grade Group (GG) 1 disease undergoing MRI-informed Biopsy 2, defined as second surveillance biopsy after diagnosis, were separated into prior vs no prior MRI-informed biopsy groups. Primary outcome was reclassification (≥GG2) at MRI-informed Biopsy 2. Reclassification rates and location (systematic cores, targeted cores, both) were compared between groups. Univariable and multivariable logistic regression identified predictors of reclassification.

Patients with (n = 101) vs without (n = 103) prior MRI-informed biopsy had lower reclassification rates at Biopsy 2 (21% vs 36%, <i>P</i> = .017) and lower GG at reclassification (95% vs 73% of reclassifications to GG2, <i>P</i> = .039). In multivariable modeling, Prostate Imaging Reporting and Data System 4 or 5 lesion at MRI-informed Biopsy 2 was associated with increased odds of reclassification (odds ratio = 2.04, 95% CI [1.04-4.05]). The negative predictive value of MRI at Biopsy 2 was 87% (95% CI [78-96]) and 73% (95% CI [61-85]) in with vs without prior MRI groups. Reclassification location was identified by targeted cores only in 36% vs 19% of patients with vs without prior MRI (<i>P</i> = .4). Reclassification location was identified by systematic cores only in 36% vs 58% of patients with vs without prior MRI (<i>P</i> = .4).

These results support MRI use at Biopsy 2 and suggest negative surveillance MRI should not replace Biopsy 2. Both targeted and systematic cores should be taken at Biopsy 2 in patients with and without prior MRI on active surveillance.

EDRN PI Authors
  • (None specified)
Medline Author List
  • Brooks JD
  • Carroll PR
  • Chappidi MR
  • Dash A
  • Filson CP
  • Gleave ME
  • Lin DW
  • Liss MA
  • Liu M
  • Martin F
  • McKenney JK
  • Morgan TM
  • Nelson PS
  • Newcomb LF
  • Schenk JM
  • Wagner AA
  • Zheng Y
  • Zhu K
  • de la Calle CM
PubMed ID
40305682
Appears In
J Urol, 2025 Sep (issue 3)