Pd13-05 Can Surveillance Biopsies Be Omitted at First Mri-Informed Surveillance Biopsy in Low-Risk Prostate Cancer Patients With Negative Mri on Active Surveillance

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD13)1 May 2024PD13-05 CAN SURVEILLANCE BIOPSIES BE OMITTED AT FIRST MRI-INFORMED SURVEILLANCE BIOPSY IN LOW-RISK PROSTATE CANCER PATIENTS WITH NEGATIVE MRI ON ACTIVE SURVEILLANCE Meera R. Chappidi, Lisa F. Newcomb, Menghan Liu, Jeannette M. Schenk, Yingye Zheng, Kehao Zhu, Claire M. de la Calle, and Daniel W. Lin Meera R. ChappidiMeera R. Chappidi , Lisa F. NewcombLisa F. Newcomb , Menghan LiuMenghan Liu , Jeannette M. SchenkJeannette M. Schenk , Yingye ZhengYingye Zheng , Kehao ZhuKehao Zhu , Claire M. de la CalleClaire M. de la Calle , and Daniel W. LinDaniel W. Lin View All Author Informationhttps://doi.org/10.1097/01.JU.0001009552.62973.71.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guidelines state negative MRI should not replace periodic surveillance biopsy (sBx) in patients on active surveillance (AS). However, with increased use of MRI at diagnostic and confirmatory biopsy (Bx), the benefit of sBxs in patients with negative surveillance MRIs should be readdressed. Our objective was to determine if negative MRI or serially negative MRIs can be used to omit sBxs in patients on AS. METHODS: Patients in Canary Prostate Active Surveillance Study with Grade group (GG) 1 disease on AS with MRI-informed sBxs from 8/2008 to 8/2022 were identified. Patients were separated into two groups (prior MRI vs. no prior MRI) based on whether they had a prior MRI-informed Bx (diagnostic and/or confirmatory Bx). First MRI-informed sBx was defined as first sBx with an associated MRI performed after confirmatory Bx. Primary outcome was reclassification defined as ≥GG2. Secondary outcome was extreme reclassification defined as ≥GG3. Two cutoffs to define positive MRI were tested - 1) PI-RADS 3-5 and 2) PI-RADS 4/5. We calculated the negative predictive value (NPV) of MRI at first MRI-informed sBx for reclassification and extreme reclassification in the two groups and among patients with serially negative MRIs. RESULTS: The analytic cohort (n=442) included 25% (n=109) with prior MRI and 75% (n=333) with no prior MRI group. Using the PI-RADS 3+ definition of positive MRI, the NPV of MRI at first MRI-informed sBx for the prior MRI vs. no prior MRI group was 86% and 82% for reclassification and 97% and 98% for extreme reclassification, respectively (Table). In patients with serially negative MRIs, the NPV was 83%. These NPVs were similar when PI-RADS 4+ was used to define positive MRI (Table). CONCLUSIONS: In low-risk prostate cancer patients on AS at first MRI-informed sBx, the NPV of MRI was comparable among patients with and without prior MRI-informed Bxs and similar in the subset of patients with serially negative MRIs using either definition of positive MRI. The NPV for extreme reclassification was very high in both patients with and without prior MRI. This suggests patients with a negative MRI, including serially negative MRIs, at first MRI-informed sBxs should still undergo sBxs due to the ∼15-20% risk of reclassification. Source of Funding: The Canary Foundation, NIH U01 CA224255 grant, Urology Care Foundation Research Scholar Award © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e264 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Meera R. Chappidi More articles by this author Lisa F. Newcomb More articles by this author Menghan Liu More articles by this author Jeannette M. Schenk More articles by this author Yingye Zheng More articles by this author Kehao Zhu More articles by this author Claire M. de la Calle More articles by this author Daniel W. Lin More articles by this author Expand All Advertisement PDF downloadLoading ...