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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2018

01-11-2018 | Urologic Oncology

Contemporary Epstein Criteria with Biopsy-Naïve Multiparametric Magnetic Resonance Imaging to Prevent Incorrect Assignment to Active Surveillance in the PI-RADS Version 2.0 Era

Authors: Yu Fan, MD, Lingyun Zhai, MD, Yisen Meng, MD, Yuke Chen, MD, Shaoshuai Sun, MD, Huihui Wang, MD, Shuai Hu, MD, PhD, Qi Shen, MD, PhD, Yi Liu, MD, Derun Li, MD, Xueru Feng, MD, Qun He, MD, PhD, Xiaoying Wang, MD, Wei Yu, MD, Jie Jin, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2018

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Abstract

Purpose

The aim of this study is to evaluate the effectiveness of multiparametric magnetic resonance imaging (mp-MRI) in prostate cancer (PCa) patients with biopsy Gleason score ≤ 6 who may otherwise be assigned to active surveillance (AS).

Patients and Methods

This was a retrospective study of 90 patients who underwent transrectal systematic biopsy for prostate cancer with Gleason score ≤ 6 without neoadjuvant therapy, with radical prostatectomy (RP) conducted between September 2009 and March 2018. All patients underwent prebiopsy mp-MRI. The prostate imaging reporting and data system (PI-RADS) version 2.0 score was evaluated. The correlation between imaging results and pathological findings was analyzed. We established models based on Epstein criteria with or without PI-RADS score and evaluated their ability for screening of potential PCa AS candidates.

Results

Among 90 patients, 60 (66.7%) had upgrade (Gleason ≥ 7), 30 (33.3%) had extraprostatic extension, and 9 (10%) had seminal vesicle invasion on RP specimens. The rate of unfavorable disease was 67.8% (61 of 90). On multivariate analysis, independent risk factors for unfavorable disease were prostate-specific antigen density and PI-RADS score. The model based on Epstein criteria with PI-RADS score showed improved integrated discrimination improvement index and was superior to the classical Epstein criteria on decision curve analysis for screening potential prostate cancer AS candidates.

Conclusions

Multiparametric MRI with PIRADS 2.0 provides useful supplementary information to Epstein criteria, and may prevent incorrect assignment to active surveillance.
Appendix
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Metadata
Title
Contemporary Epstein Criteria with Biopsy-Naïve Multiparametric Magnetic Resonance Imaging to Prevent Incorrect Assignment to Active Surveillance in the PI-RADS Version 2.0 Era
Authors
Yu Fan, MD
Lingyun Zhai, MD
Yisen Meng, MD
Yuke Chen, MD
Shaoshuai Sun, MD
Huihui Wang, MD
Shuai Hu, MD, PhD
Qi Shen, MD, PhD
Yi Liu, MD
Derun Li, MD
Xueru Feng, MD
Qun He, MD, PhD
Xiaoying Wang, MD
Wei Yu, MD
Jie Jin, MD, PhD
Publication date
01-11-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6720-2

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