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The natural history of prostate cancer on MRI: lessons from an active surveillance cohort

Prostate Cancer and Prostatic Diseases volume 21, pages 556–563 (2018)Cite this article

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Abstract

Background:

Multiparametric magnetic resonance imaging (mpMRI) is being used increasingly in the setting of active surveillance (AS) for prostate cancer. We investigated changes in the mpMRI appearance of lesions on AS, to show the variability of volume measurements in visible lesions and assess change in lesion size according to grade.

Methods:

We retrospectively retrieved 86 men on AS (NICE guidelines) with more than one mpMRI (the first before 2013). Two radiologists, in consensus, were blinded to patient demographics and date of scan. The scans were randomly reported to reduce any bias. For visible lesions, we measured volume by planimetry on the sequence best showing the most conspicuous (index) tumour and attributed a 5-point Likert score.

Results:

43/86 men did not have a visible lesion on the initial mpMRI (≤2/5). Of these, 5/43 had developed a lesion scoring ≥3/5 at a median of 3.6 years of follow up. 40/86 had a lesion scoring ≥3/5 on two or more scans. There was a significant increase in volume over 3.6 years by a median of 10% (p < 0.01)–by a median of 6% for Gleason 3+3 and 18% for 3+4 (p = 0.058). Thirty-five men had a visible lesion on two scans separated by <2 years; of these, 21/35 showed a 78% median increase in tumour size between the two scans and 11/35 showed an apparent 25% median decrease in lesion size.

Conclusions:

A total of 17% of men with no visible lesion developed a visible lesion at a median follow up of 3.6 years. It is possible to show significant growth in patients with a visible lesion, but variability in volume measurements between scans means that it is difficult to reliably detect increases of this order. This variability may inform the design of mpMRI protocols in AS and the time between follow up scans.

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Authors and Affiliations

  1. Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK

    Francesco Giganti, Shonit Punwani, Clare Allen & Alex Kirkham

  2. Division of Surgery and Interventional Science, University College London, London, UK

    Francesco Giganti, Caroline M. Moore & Mark Emberton

  3. Department of Urology, University College London Hospital NHS Foundation Trust, London, UK

    Caroline M. Moore & Mark Emberton

  4. Centre for Medical Imaging, University College London, London, UK

    Shonit Punwani

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  1. Francesco Giganti
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  2. Caroline M. Moore
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Correspondence to Francesco Giganti.

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Conflict of interest

The authors of this manuscript declare relationships with the following companies: F.G. is funded by the UCL Graduate Research Scholarship and the Brahm PhD scholarship in memory of Chris Adams. M.E. is a UK National Institute of Health Research (NIHR) Senior Investigator. In addition, he receives research support from the UCLH/UCL NIHR Biomedical Research Centre. A.K. receives research support from the UCLH/UCL NIHR Biomedical Research Centre.

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Giganti, F., Moore, C.M., Punwani, S. et al. The natural history of prostate cancer on MRI: lessons from an active surveillance cohort. Prostate Cancer Prostatic Dis 21, 556–563 (2018). https://doi.org/10.1038/s41391-018-0058-5

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