Upfront MRI may help predict aggressive disease in intermediate-risk prostate cancer

Data recently published in the Journal of Urology suggest that suspicious findings on MRI at baseline may be predictive of more aggressive disease within 5 years in patients with intermediate-risk prostate cancer, underscoring the importance of upfront MRI before initiating active surveillance.¹

All those included in the study underwent MRI within 6 months before or after initial biopsy.

“While active surveillance is the standard of care for low-risk patients, it's been unclear whether patients with a slower-growing form of intermediate-risk prostate cancer should be carefully watched or undergo immediate treatment,” lead author Kiran R. Nandalur, MD, a radiologist at Corewell Health William Beaumont University Hospital in Royal Oak, Michigan, said in a news release on the findings.² “Our data suggest that an MRI can show suspicious lesions based on size and markers of tumor aggression, which may help doctors differentiate a treatment path for these patients.”

Overall, 36% of patients included in the study who were on active surveillance demonstrated more aggressive disease within 5 years.

Data showed that a PI-RADS score of 4 or greater at baseline was associated with an increased hazard of early biopsy reclassification at follow-up (HR, 2.3; 95% CI, 1.6-3.2; P < .001). Grade group 2 vs 1 (HR, 2.5; 95% CI, 1.7-3.7; P < .001) and increasing age (per 10 years; HR, 1.8; 95% CI, 1.4-2.4; P < .001) were also associated with a baseline PI-RADS score of 4 or greater. There was no significant association found between NCCN risk group and MRI findings (P = .7).

These results translate to a 130% increased risk of more aggressive disease among those with high-risk features on imaging. Additionally, both those with low-risk and intermediate-risk disease had twice the risk of aggressive disease when suspicious lesions were found on MRI. According to the news release, this is the first demonstration of that finding among intermediate-risk patients.²

In total, the multicenter cohort study included 1491 men with low- and intermediate-risk prostate cancer. The median age of participants was 64 years, and the median follow-up was 11.0 months. Participants were identified for the study via the Michigan Urological Surgical Improvement Collaborative registry.

All those included in the study underwent MRI within 6 months before or after initial biopsy and were started on active surveillance between June 2016 and January 2021. The primary outcome measure was the association between baseline MRI PI-RADS score (≥4 lesion) with reclassification to high grade prostate cancer (≥ grade group 3).

“The implication for patients and doctors is that an upfront MRI is important before undertaking any active surveillance for prostate cancer since it may help predict if an individual might come back with worse disease later,” Nandalur concluded in the news release.² “This type of imaging helps pave the way for treatment planning so patients can live their lives to the fullest whether they decide to watch their cancer or seek treatment.”

References

1. Nandalur KR, Shen C, Zhao L, et al. Association of baseline magnetic resonance imaging prostate imaging reporting and data system score with prostate cancer active surveillance early biopsy reclassification: Data from the Michigan Urological Surgery Improvement Collaborative (MUSIC). J Urol. 2024:101097JU0000000000004117. doi:10.1097/JU.0000000000004117

2. Study suggests an MRI may help doctors predict more aggressive prostate cancer in patients. News release. Corewell Health. Published online and accessed August 7, 2024. https://www.newswise.com/articles/study-suggests-an-mri-may-help-doctors-predict-more-aggressive-prostate-cancer-in-patients