Featured Research

from universities, journals, and other organizations

MRI helps identify patients with prostate cancer who may benefit from active surveillance

Date:
September 24, 2012
Source:
Elsevier
Summary:
PSA screening has resulted in improved prostate cancer survival, but the high rate of diagnosis and treatment side effects raise concerns about overtreatment. In the quest to prevent overtreatment, "active surveillance" has emerged as a plausible option, encouraged for men whose tumors may not need immediate treatment and may never progress to more serious illness. Appropriate criteria for selecting patients for active surveillance are continuously debated. A group of investigators report that adding endorectal magnetic resonance imaging (MRI) to the initial clinical evaluation of men with clinically low prostate cancer risk helps assess eligibility for active surveillance.

PSA screening has resulted in improved prostate cancer survival, but the high rate of diagnosis and treatment side effects raise concerns about overtreatment. In the quest to prevent overtreatment, "active surveillance" has emerged as a plausible option, encouraged for men whose tumors may not need immediate treatment and may never progress to more serious illness. Appropriate criteria for selecting patients for active surveillance are continuously debated. A group of investigators from Memorial Sloan-Kettering Cancer Center in New York report that adding endorectal magnetic resonance imaging (MRI) to the initial clinical evaluation of men with clinically low prostate cancer risk helps assess eligibility for active surveillance.

Their results are published in The Journal of Urology.

"Among patients initially diagnosed with clinically low risk prostate cancer, those with tumors not clearly visualized on MRI were significantly more likely to demonstrate low risk features when a confirmatory biopsy was performed, while patients with tumors clearly visualized on MRI were significantly more likely to have their disease status upgraded on confirmatory biopsy," says lead investigator Hebert Alberto Vargas, MD, Department of Radiology, Memorial Sloan-Kettering Cancer Center.

Researchers evaluated 388 patients who had an initial prostate biopsy performed between 1999 and 2010, had a Gleason score (measures prostate cancer aggressiveness) of 6 or less, and had a biopsy to confirm the assessment within 6 months of initial diagnosis. An endorectal MRI was performed in all patients between the initial and confirmatory biopsies.

MRI studies were interpreted by three radiologists with different levels of experience. One was a fellowship trained radiologist who had read only about 50 prostate MRI examinations before the study (reader 1). The second was a fellow with dedicated training in prostate imaging who had read approximately 500 prostate MRI examinations (reader 2). The third was a fellowship trained radiologist who had interpreted over 5,000 prostate MRI examinations (reader 3). They each assigned a score of 1 to 5 for the presence of tumor on MRI, with 1 being definitely no tumor and 5 being definitely tumor.

On confirmatory biopsy, Gleason scores were upgraded in 79 (20%) cases. Patients with higher MRI scores were more likely to have disease upgraded on confirmatory biopsy. An MRI score of 2 or less was highly associated with low risk features on confirmatory biopsy. Agreement on MRI scores was substantial between readers 2 and 3, but only fair between reader 1 and readers 2 and 3. "These results suggest that MRI of the prostate, if read by radiologists with appropriate training and experience, could help determine active surveillance eligibility and obviate the need for confirmatory biopsy in substantial numbers of patients," notes Dr. Vargas.

Active surveillance allows patients with low grade tumors avoid negative side effects of prostate cancer treatment including erectile dysfunction and bladder problems. The success of active surveillance relies primarily on the accurate identification of patients with low risk disease unlikely to have disease progression. "The fact that clear tumor visualization on MRI was predictive of upgrading on confirmatory prostate biopsy suggests that prostate MRI may contribute to the complex process of assessing patient eligibility for active surveillance," Dr. Vargas concludes.

In an editorial in the same issue of The Journal, Guillaume Ploussard, MD, PhD, of the CHU Saint-Louis, APHP, Paris, France, notes "The primary issue is to reduce the number of clinical settings in which the urologist and the patient face the situation of an increased PSA and an uncertain diagnosis. MRI might help to limit the risk of biopsy under grading. In cases of normal signal in the whole gland, the patient might be reassured and re-biopsy delayed. In cases of a suspicious nodule, re-biopsy would be better justified, and biopsy cores could target specific zones."


Story Source:

The above story is based on materials provided by Elsevier. Note: Materials may be edited for content and length.


Journal Reference:

  1. H.A. Vargas, O. Akin, A. Afaq, et al. The Value of Magnetic Resonance Imaging in Predicting Confirmatory Prostate Biopsy Findings in Patients Being Considered for Active Surveillance of Clinically Low Risk Prostate Cancer. The Journal of Urology, 2012 DOI: 10.1016/j.juro.2012.076.024

Cite This Page:

Elsevier. "MRI helps identify patients with prostate cancer who may benefit from active surveillance." ScienceDaily. ScienceDaily, 24 September 2012. <www.sciencedaily.com/releases/2012/09/120924175034.htm>.
Elsevier. (2012, September 24). MRI helps identify patients with prostate cancer who may benefit from active surveillance. ScienceDaily. Retrieved July 28, 2014 from www.sciencedaily.com/releases/2012/09/120924175034.htm
Elsevier. "MRI helps identify patients with prostate cancer who may benefit from active surveillance." ScienceDaily. www.sciencedaily.com/releases/2012/09/120924175034.htm (accessed July 28, 2014).

Share This




More Health & Medicine News

Monday, July 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Traditional African Dishes Teach Healthy Eating

Traditional African Dishes Teach Healthy Eating

AP (July 28, 2014) Classes are being offered nationwide to encourage African Americans to learn about cooking fresh foods based on traditional African cuisine. The program is trying to combat obesity, heart disease and other ailments often linked to diet. (July 28) Video provided by AP
Powered by NewsLook.com
West Africa Gripped by Deadly Ebola Outbreak

West Africa Gripped by Deadly Ebola Outbreak

AFP (July 28, 2014) The worst-ever outbreak of the deadly Ebola epidemic grips west Africa, killing hundreds. Duration: 00:48 Video provided by AFP
Powered by NewsLook.com
Trees Could Save More Than 850 Lives Each Year

Trees Could Save More Than 850 Lives Each Year

Newsy (July 27, 2014) A national study conducted by the USDA Forest Service found that trees collectively save more than 850 lives on an annual basis. Video provided by Newsy
Powered by NewsLook.com
Google's Next Frontier: The Human Body

Google's Next Frontier: The Human Body

Newsy (July 27, 2014) Google is collecting genetic and molecular information to paint a picture of the perfectly healthy human. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins