Mp31-05 5-Alpha Reductase Inhibitor Use Reduces the Clinical Performance of Multiparametric Mri in the Detection of Clinically Significant Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (MP31)1 May 2024MP31-05 5-ALPHA REDUCTASE INHIBITOR USE REDUCES THE CLINICAL PERFORMANCE OF MULTIPARAMETRIC MRI IN THE DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER Arighno Das, Marcelo Bigarella, Krista N. Brackman, Christopher P. Filson, Melina Pectasides, Soroush Rais-Bahrami, Andrew Fang, Ashanda Esdaille, Tudor Borza, Shane Wells, Giuseppe Toia, and David Jarrard Arighno DasArighno Das , Marcelo BigarellaMarcelo Bigarella , Krista N. BrackmanKrista N. Brackman , Christopher P. FilsonChristopher P. Filson , Melina PectasidesMelina Pectasides , Soroush Rais-BahramiSoroush Rais-Bahrami , Andrew FangAndrew Fang , Ashanda EsdailleAshanda Esdaille , Tudor BorzaTudor Borza , Shane WellsShane Wells , Giuseppe ToiaGiuseppe Toia , and David JarrardDavid Jarrard View All Author Informationhttps://doi.org/10.1097/01.JU.0001008936.35187.0b.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiparametric MRI (mpMRI) is an important tool for the diagnosis of clinically significant prostate cancer (csPCa). 5-alpha reductase inhibitors (5-ARI) alter blood flow, potentially altering MRI features of PCa lesions. Our objective was to investigate the impact of 5-ARI use on PI-RADS lesion imaging characteristics and its impact on mpMRI detection of csPCa. METHODS: Clinicopathologic data from a multi-institutional cohort of 1108 PI-RADSv2.1 3-5 lesions from 716 patients were analyzed. All patients underwent targeted MRI-guided biopsy of these lesions. Corrected PSA (cPSA) was calculated for men on 5-ARI by doubling the PSA. RESULTS: In this multicenter cohort, 90/1108 (8%) of lesions were in men on 5-ARI >3 months at time of mpMRI. PSA did not differ (p=0.6), but cPSA was higher in men on 5-ARI (16 ng/mL vs 8 ng/mL, p<0.001). Adjusted for age, cPSA, prostate volume, PI-RADS score, and prior biopsy history, targeted biopsy of PI-RADS 3-5 lesions in men on 5-ARI were significantly less likely to identify csPCa (OR 0.32, 95% CI 0.18, 0.57, Figure 1). To understand this finding, 66 mpMRI lesions in patients on 5-ARI were matched with 66 mpMRI lesions in patients not on 5-ARI on the basis of age, cPSA, prostate volume, PI-RADS score, and prior biopsy history. All 132 mpMRI lesions were re-reviewed by a fellowship-trained radiologist, blinded to the 5-ARI status. Apparent diffusion coefficient (ADC) was measured for the PI-RADS lesions, non-tumor peripheral zone, and non-tumor transition zone of the prostate. Imaging analysis demonstrated that average ADC was higher in peripheral zone lesions in men on 5-ARI (869 mm2/s vs765 mm2/s, p=0.04) with no change in non-tumor peripheral zone tissue (p=0.2). There was no difference in the ADC of transition zone lesions (p=0.2), and non-tumor transition zone tissue (p=0.06). Multivariable analysis in the matched groups validated that 5-ARI use was associated with a significantly lower likelihood of csPCa detection on targeted biopsy (OR 0.32, 95% CI 0.12, 0.80). CONCLUSIONS: Targeted biopsy of PI-RADS 3-5 lesions was significantly less likely to identify csPCa in men on 5-ARI at the time of mpMRI. Peripheral zone mpMRI lesions in men on 5-ARI have higher lesion ADCs which may lead to more biopsies and false positives in this population. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e505 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Arighno Das More articles by this author Marcelo Bigarella More articles by this author Krista N. Brackman More articles by this author Christopher P. Filson More articles by this author Melina Pectasides More articles by this author Soroush Rais-Bahrami More articles by this author Andrew Fang More articles by this author Ashanda Esdaille More articles by this author Tudor Borza More articles by this author Shane Wells More articles by this author Giuseppe Toia More articles by this author David Jarrard More articles by this author Expand All Advertisement PDF downloadLoading ...