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Magnetic resonance imaging for long-term active surveillance biopsy decision-making

Leni, Riccardo ; Tin, Amy L. ; Liso, Nicole ; Carlsson, Sigrid V. LU ; Akin, Oguz ; Montorsi, Francesco ; Briganti, Alberto ; Eastham, James A. ; Vickers, Andrew J. and Ehdaie, Behfar (2025) In BJU International 136(3). p.500-506
Abstract

Objectives: To evaluate whether long-term magnetic resonance imaging (MRI) findings, alone or in combination with prostate-specific antigen (PSA) density or the result of prior surveillance biopsies, could be used to omit biopsies occurring after patients have been on active surveillance (AS) for ≥5 years. Patients and Methods: Analysis of a single-institution AS cohort of patients with Grade Group (GG) 1 prostate cancer who underwent a scheduled 6-year MRI and biopsy. Multivariable logistic regression was used to test the association between the Prostate Imaging-Reporting and Data System (PI-RADS) score, PSA density, status of prior AS biopsy, and reclassification to GG ≥2. We then analysed how many GG ≥2 cancers would be missed if the... (More)

Objectives: To evaluate whether long-term magnetic resonance imaging (MRI) findings, alone or in combination with prostate-specific antigen (PSA) density or the result of prior surveillance biopsies, could be used to omit biopsies occurring after patients have been on active surveillance (AS) for ≥5 years. Patients and Methods: Analysis of a single-institution AS cohort of patients with Grade Group (GG) 1 prostate cancer who underwent a scheduled 6-year MRI and biopsy. Multivariable logistic regression was used to test the association between the Prostate Imaging-Reporting and Data System (PI-RADS) score, PSA density, status of prior AS biopsy, and reclassification to GG ≥2. We then analysed how many GG ≥2 cancers would be missed if the 6-year biopsy was avoided based on significant predictors. Results: In all, 49 of 221 men (22%) were reclassified to GG ≥2. PSA density and PI-RADS scores 4–5 were significant predictors; a prior negative AS biopsy was inversely associated with GG ≥2. The risk of missing GG ≥2 if the 6-year biopsy is omitted in men with an unsuspicious MRI (PI-RADS 1–2) was 12% (95% confidence interval [CI] 5.3–19%). After testing combinations of MRI findings, PSA density, and the status of the prior biopsy, we found the lowest risk of GG ≥2 in patients with a prior negative biopsy and PSA density of <0.10 ng/mL/cc (5.3%, 95% CI 1.5–10%). Conclusions: An unsuspicious MRI at 6 years is not enough alone to omit the 6-year AS biopsy under current guidelines. Combining MRI findings, PSA density, and prior negative AS biopsies is a promising strategy to tailor surveillance intensity. Our findings should be replicated in larger cohorts prior to implementation in clinical practice.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
active surveillance, multiparametric magnetic resonance imaging, prostate cancer, reclassification, surveillance biopsy
in
BJU International
volume
136
issue
3
pages
7 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:105007071254
  • pmid:40437977
ISSN
1464-4096
DOI
10.1111/bju.16798
language
English
LU publication?
yes
id
67c52353-edb3-487f-bd76-5a2842147dda
date added to LUP
2025-09-22 15:52:31
date last changed
2025-10-20 12:21:47
@article{67c52353-edb3-487f-bd76-5a2842147dda,
  abstract     = {{<p>Objectives: To evaluate whether long-term magnetic resonance imaging (MRI) findings, alone or in combination with prostate-specific antigen (PSA) density or the result of prior surveillance biopsies, could be used to omit biopsies occurring after patients have been on active surveillance (AS) for ≥5 years. Patients and Methods: Analysis of a single-institution AS cohort of patients with Grade Group (GG) 1 prostate cancer who underwent a scheduled 6-year MRI and biopsy. Multivariable logistic regression was used to test the association between the Prostate Imaging-Reporting and Data System (PI-RADS) score, PSA density, status of prior AS biopsy, and reclassification to GG ≥2. We then analysed how many GG ≥2 cancers would be missed if the 6-year biopsy was avoided based on significant predictors. Results: In all, 49 of 221 men (22%) were reclassified to GG ≥2. PSA density and PI-RADS scores 4–5 were significant predictors; a prior negative AS biopsy was inversely associated with GG ≥2. The risk of missing GG ≥2 if the 6-year biopsy is omitted in men with an unsuspicious MRI (PI-RADS 1–2) was 12% (95% confidence interval [CI] 5.3–19%). After testing combinations of MRI findings, PSA density, and the status of the prior biopsy, we found the lowest risk of GG ≥2 in patients with a prior negative biopsy and PSA density of &lt;0.10 ng/mL/cc (5.3%, 95% CI 1.5–10%). Conclusions: An unsuspicious MRI at 6 years is not enough alone to omit the 6-year AS biopsy under current guidelines. Combining MRI findings, PSA density, and prior negative AS biopsies is a promising strategy to tailor surveillance intensity. Our findings should be replicated in larger cohorts prior to implementation in clinical practice.</p>}},
  author       = {{Leni, Riccardo and Tin, Amy L. and Liso, Nicole and Carlsson, Sigrid V. and Akin, Oguz and Montorsi, Francesco and Briganti, Alberto and Eastham, James A. and Vickers, Andrew J. and Ehdaie, Behfar}},
  issn         = {{1464-4096}},
  keywords     = {{active surveillance; multiparametric magnetic resonance imaging; prostate cancer; reclassification; surveillance biopsy}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{500--506}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{BJU International}},
  title        = {{Magnetic resonance imaging for long-term active surveillance biopsy decision-making}},
  url          = {{http://dx.doi.org/10.1111/bju.16798}},
  doi          = {{10.1111/bju.16798}},
  volume       = {{136}},
  year         = {{2025}},
}