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Annals of Surgical Oncology

, Volume 25, Issue 12, pp 3510–3517 | Cite as

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

  • Yu Fan
  • Lingyun Zhai
  • Yisen Meng
  • Yuke Chen
  • Shaoshuai Sun
  • Huihui Wang
  • Shuai Hu
  • Qi Shen
  • Yi Liu
  • Derun Li
  • Xueru Feng
  • Qun He
  • Xiaoying Wang
  • Wei Yu
  • Jie Jin
Urologic Oncology

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.

Notes

Acknowledgment

The authors thank the entire staff of the Department of Urology and Department of Radiology, Peking University First Hospital.

Funding

This paper was supported by Youth clinical research project of Peking University First Hospital (Grant No. 2017CR07); National Key research and development program of China (Grant No. 2017YFC0908003); Tibetian Natural Science Foundation (Grant No. XZ2017ZR-ZY019).

Disclosure

The authors have declared that no competing interest exist.

Supplementary material

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Supplementary material 1 (TIFF 425 kb)
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Supplementary material 2 (TIFF 2878 kb)
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Supplementary material 3 (TIFF 318 kb)

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Yu Fan
    • 1
    • 2
    • 3
    • 7
  • Lingyun Zhai
    • 1
    • 2
    • 3
  • Yisen Meng
    • 1
    • 2
    • 3
  • Yuke Chen
    • 1
    • 2
    • 3
  • Shaoshuai Sun
    • 4
  • Huihui Wang
    • 4
  • Shuai Hu
    • 1
    • 2
    • 3
    • 5
  • Qi Shen
    • 1
    • 2
    • 3
    • 5
  • Yi Liu
    • 1
    • 2
    • 3
  • Derun Li
    • 1
    • 2
    • 3
  • Xueru Feng
    • 6
  • Qun He
    • 1
    • 2
    • 3
    • 5
  • Xiaoying Wang
    • 4
  • Wei Yu
    • 1
    • 2
    • 3
  • Jie Jin
    • 1
    • 2
    • 3
  1. 1.Department of UrologyPeking University First HospitalBeijingChina
  2. 2.Institute of UrologyPeking UniversityBeijingChina
  3. 3.National Urological Cancer CenterBeijingChina
  4. 4.Department of RadiologyPeking University First HospitalBeijingChina
  5. 5.Department of Genitourinary PathologyPeking University First HospitalBeijingChina
  6. 6.Department of GeriatricsPeking University First HospitalBeijingChina
  7. 7.Department of UrologyTibet Autonomous Region People’s HospitalLhasaChina

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