Impact of Multiparametric MRI and PSA Density on the Initial Indication or the Maintaining in Active Surveillance During Follow-Up in low-Risk Prostate Cancer.

We assessed the impact of MRI and PSA density on the probability to pursue an active surveillance of prostate cancer. We found that the use of these characteristics could improve selection of patients at diagnosis, stratifying the delayed treatment risk. During follow-up, some biopsies could be avoided with a reasonably risk and higher MRI lesion were at high-risk of treatment. Introduction: A greater selection of candidates for active surveillance (AS) of prostate cancer (PCa) may decrease the rate of delayed treatment. We aimed to study: 1) the impact of MRI and PSA density (PSAd) at baseline on the final status, and 2) the impact of bio-clinical features during the follow-up on pursuing AS. Materials and Methods: This retrospective, monocentric study between June 2013 and July 2020, included 99 patients in AS (median follow-up: 19 months [18-92]). All MRI were reviewed by a single radiologist. Lost to follow-up were 17 patients and 6 patients chose treatment by themselves. Treatment was proposed in case of upgrading (= GG2) or increasing PCa volume. Results: Impact of MRI and PSAd at baseline: Combining PSAd = 0.15 and PIRADS = 3, the probability to remain in AS was 72%. This rate reached 83% when PSAd = 0.10 was associated to normal MRI. During follow-up: One hundred fiftyseven prostatic biopsies (PBx) were performed and 38 (24%) found PCa upgrading. The association between negative MRI and PSAd = 0.10, during follow-up, had an excellent NPV to predict treatment (95%). This combination concerned 25% (37/151) of surveillance biopsies that could have been avoided at the cost of delaying upgrading in 3% (1/37). In multivariate analysis, only PIRADS = 4 before PBx was associated to a risk of treatment during follow-up (OR, 10.4 [95% CI, 4.2-25.8]; P < .0001). Conclusion: Using PSAd and MRI at baseline to select patients showed excellent performances to predict the maintenance in AS. During follow-up, MRI PIRADS = 4 was associated to an increased risk of treatment. [ABSTRACT FROM AUTHOR]