A new study published in the American Urological Association Journal of Urology adds the largest cohort data to the body of literature for MRI in active surveillance of prostate cancer. The study, funded by the Canary Foundation, investigated the ability of prostate MRI to detect Gleason Grade Group (GG) ≥2 cancer in a standardised, multi-institutional active surveillance cohort and concluded with the recommendation of systematic biopsy in patients with a negative MRI and the inclusion of systematic biopsy in patients with a positive MRI.
Men enrolled in the Canary Foundation’s Prostate Active Surveillance Study (PASS) with GG<2 and who underwent a biopsy within 12 months of a multiparametric MRI were evaluated. The study’s primary outcome was biopsy reclassification to GG2 or greater.
There were 361 participants with 395 prostate MRIs with a median follow-up of 4.1 (IQR: 2.0-7.6) years. Overall, 108/395 (27%) biopsies showed reclassification. Defining positive MRI as PIRADS 3-5, the NPV and PPV for detecting GG ≥2 cancer was 83% (95% CI: 76-90%) and 31% (95% CI: 26-37%), respectively. PIRADS was significantly associated with reclassification (PIRADS 5 versus 1 and 2: OR = 2.71; 95% CI: 1.21-6.17, p = 0.016) in a multivariable model but did not improve upon a model with only clinical factors (AUC 0.768 versus 0.762). In 194 fusion biopsies, higher grade cancer was found in targeted cores in 21 (11%) instances, while 25 (13%) had higher grade cancer found in the systematic cores.
This highlights the important role of both Magnetic Resonance Imaging and systematic biopsy in the prostate cancer pathway in accurately detecting potential incidence of cancer.
The study also mentions that systematic biopsy should be done in a safe, convenient and effective manner.
BXTAccelyon is pleased to be able to support patients and clinicians throughout the full prostate cancer pathway, with the recent addition of the online MRI training platform MRI Pro to our services, addressing the global demand for healthcare professionals experienced in interpreting and accurate reporting of MRI scans.
In addition, our PrecisionPoint™ transperineal (TP) access system from Perineologic is transforming the traditional TRUS prostate biopsy, and is a proven method for more accurate cancer detection in a safer, more convenient manner. This medical system takes full advantage of the transperineal path – decreasing the risk of infection - to more thoroughly sample all regions of the prostate including those difficult to access with the transrectal approach. Performed under local anaesthetic (TP LA), the procedure can be conducted in an outpatient setting – more important now than ever before as healthcare systems globally battle the COVID-19 pandemic.