Can MRI Help Inform Which Men With a History of Multifocal High-Grade Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation Remain at an Elevated Risk for Clinically Significant Prostate Cancer?

No AccessJournal of UrologyAdult Urology6 Nov 2023Can MRI Help Inform Which Men With a History of Multifocal High-Grade Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation Remain at an Elevated Risk for Clinically Significant Prostate Cancer? Michael S. Sessine, Codrut S. Radoiu, Ji Qi, Corinne Labardee, Frank Burks, Arvin K. George, Brian R. Lane, Kenneth Lim, Ali Dabaja, Todd M. Morgan, Michael L. Cher, Alice M. Semerjian, and Kevin B. Ginsburg Michael S. SessineMichael S. Sessine *Corresponding Author: Michael S. Sessine, Department of Urology, Wayne State University, 7C UHC 4201 St. Antoine, Detroit, MI 48201 E-mail Address: [email protected] Department of Urology, Wayne State University, Detroit, Michigan More articles by this author , Codrut S. RadoiuCodrut S. Radoiu Department of Urology, Wayne State University, Detroit, Michigan More articles by this author , Ji QiJi Qi Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Corinne LabardeeCorinne Labardee Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Frank BurksFrank Burks Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan More articles by this author , Arvin K. GeorgeArvin K. George Department of Urology, University of Michigan, Ann Arbor, Michigan James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author , Brian R. LaneBrian R. Lane Division of Urology, Corewell Health, Grand Rapids, Michigan More articles by this author , Kenneth LimKenneth Lim Detroit Medical Center, Detroit, Michigan More articles by this author , Ali DabajaAli Dabaja Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , Todd M. MorganTodd M. Morgan Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Michael L. CherMichael L. Cher Department of Urology, Wayne State University, Detroit, Michigan More articles by this author , Alice M. SemerjianAlice M. Semerjian Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , and Kevin B. GinsburgKevin B. Ginsburg Department of Urology, Wayne State University, Detroit, Michigan More articles by this author for the Michigan Urological Surgery Improvement Collaborative (MUSIC) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003775AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: We investigated the association of MRI findings in men with a previous diagnosis of atypical small acinar proliferation (ASAP) or multifocal high-grade intraepithelial neoplasia (HGPIN) with pathologic findings on repeat biopsy. Materials and Methods: We retrospectively reviewed patients with ASAP/multifocal HGPIN undergoing a repeat biopsy in the Michigan Urological Surgery Improvement Collaborative registry. We included men with and without an MRI after the index biopsy demonstrating ASAP/multifocal HGPIN but before the repeat biopsy. Men with an MRI prior to the index biopsy were excluded. We compared the proportion of men with ≥GG2 CaP (Grade Group 2 prostate cancer) on repeat biopsy among the following groups with the χ2 test: no MRI, PIRADS (Prostate Imaging–Reporting and Data System) ≥ 4, and PIRADS ≤3. Multivariable models were used to estimate the adjusted association between MRI findings and ≥GG2 CaP on repeat biopsy. Results: Among the 207 men with a previous diagnosis of ASAP/multifocal HGPIN that underwent a repeat biopsy, men with a PIRADS ≥4 lesion had a higher proportion of ≥GG2 CaP (56%) compared with men without an MRI (12%, P < .001). A lower proportion of men with PIRADS ≤3 lesions had ≥ GG2 CaP (3.0%) compared with men without an MRI (12%, P = .13). In the adjusted model, men with a PIRADS 4 to 5 lesion had higher odds (OR: 11.4, P < .001) of ≥ GG2 CaP on repeat biopsy. Conclusions: MRI is a valuable diagnostic tool to triage which men with a history of ASAP or multifocal HGPIN on initial biopsy should undergo or avoid repeat biopsy without missing clinically significant CaP. REFERENCES 1. . Precursors of prostate cancer. Histopathology.2012; 60(1):4-27. Crossref, Medline, Google Scholar 2. . Follow-up of atypical prostate needle biopsies suspicious for cancer. Urology.1999; 53(2):351-355. Crossref, Medline, Google Scholar 3. . Predictors of cancer in repeat extended multisite prostate biopsy in men with previous negative extended multisite biopsy. Urology.2002; 60(5):836-840. Crossref, Medline, Google Scholar 4. . Atypical small acinar proliferation (ASAP): is a repeat biopsy necessary ASAP? A multi-institutional review. Prostate Cancer Prostatic Dis.2016; 19(1):68-71. Crossref, Medline, Google Scholar 5. . Role of multiparametric prostate MRI in the management of prostate cancer. World J Urol.2021; 39(3):651-659. 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Link, Google Scholar Support: Funding from Blue Cross Blue Shield of Michigan. Conflict of Interest Disclosures: J.Q., C.L., A.K.G., B.L., A.S., K.B.G.: Salary support through MUSIC. All other authors have nothing to disclose. Ethics Statement: All participating sites obtained Institutional Review Board approval or exemption for the purposes of this retrospective review. Author Contributions: All Authors listed have made substantial contributions to the design of the work, drafting of the work and review and final approval of the manuscript and agree to be accountable for all aspects of the work. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsatypical small acinar proliferationmultifocal high-grade intraepithelial neoplasiaMRIMetrics Author Information Michael S. Sessine Department of Urology, Wayne State University, Detroit, Michigan *Corresponding Author: Michael S. Sessine, Department of Urology, Wayne State University, 7C UHC 4201 St. Antoine, Detroit, MI 48201 E-mail Address: [email protected] More articles by this author Codrut S. Radoiu Department of Urology, Wayne State University, Detroit, Michigan More articles by this author Ji Qi Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Corinne Labardee Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Frank Burks Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan More articles by this author Arvin K. George Department of Urology, University of Michigan, Ann Arbor, Michigan James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author Brian R. Lane Division of Urology, Corewell Health, Grand Rapids, Michigan More articles by this author Kenneth Lim Detroit Medical Center, Detroit, Michigan More articles by this author Ali Dabaja Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Todd M. Morgan Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Michael L. Cher Department of Urology, Wayne State University, Detroit, Michigan More articles by this author Alice M. Semerjian Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Kevin B. Ginsburg Department of Urology, Wayne State University, Detroit, Michigan More articles by this author Expand All Support: Funding from Blue Cross Blue Shield of Michigan. Conflict of Interest Disclosures: J.Q., C.L., A.K.G., B.L., A.S., K.B.G.: Salary support through MUSIC. All other authors have nothing to disclose. Ethics Statement: All participating sites obtained Institutional Review Board approval or exemption for the purposes of this retrospective review. Author Contributions: All Authors listed have made substantial contributions to the design of the work, drafting of the work and review and final approval of the manuscript and agree to be accountable for all aspects of the work. Advertisement PDF downloadLoading ...