Is suspicious upstaging on multiparametric magnetic resonance imaging useful in improving the reliability of Prostate Cancer Research International Active Surveillance (PRIAS) criteria? Use of the K-CaP registry

Abstract

BACKGROUND AND OBJECTIVE:

To evaluate the clinical effects of suspicious upstaging on multiparametric magnetic resonance imaging (mpMRI) for improving the quality of Prostate Cancer Research International Active Surveillance (PRIAS) criteria.

MATERIAL AND METHODS:

A total of 363 patients with low-risk prostate cancer (PCa) were selected from the K-CaP registry (the multicenter Korean PCa Database). Patients were divided into 2 groups according to the results of mpMRI (with or without suspicious upstaging). The variables for predicting significant PCa, defined as locally advanced PCa, Gleason score≥7, or tumor volume>0.5cc or all of these, and adverse PCa, defined as locally advanced PCa, Gleason score≥7 (4+3), or tumor volume>2.5cc or all of these, were assessed.

RESULTS:

The mpMRI led to "suspicious" upstaging in 56 patients (15.4%). Significant PCa (98.2% vs. 74.6%, P<0.001) and adverse PCa (85.7% vs. 32.6%, P<0.001) were more common in patients with suspicious upstaging. The sensitivity/specificity of mpMRI for significant PCa and adverse PCa were 25.4%/98.2% and 32.4%/96.3%, respectively. On multivariate analyses, suspicious upstaging on mpMRI (odds ratio: 15.82, P = 0.007) was a predictor for significant PCa in addition to PRIAS criteria and age at diagnosis. In addition, suspicious upstaging on mpMRI (odds ratio: 11.11, P<0.001) was a significant predictor for adverse PCa in addition to PRIAS criteria, age at diagnosis, and body mass index.

CONCLUSION:

Along with the PRIAS criteria, suspicious upstaging on mpMRI is a potent diagnostic tool for distinguishing patients suitable for active surveillance among patients with low-risk PCa.