TY  - JOUR
AU  - Schoots, Ivo G.
AU  - Osses, Daniel F.
AU  - Drost, Frank-Jan H.
AU  - Verbeek, Jan F. M.
AU  - Remmers, Sebastiaan
AU  - van Leenders, Geert J. L. H.
AU  - Bangma, Chris H.
AU  - Roobol, Monique J.
PY  - 2018
TI  - Reduction of MRI-targeted biopsies in men with low-risk prostate cancer on active surveillance by stratifying to PI-RADS and PSAdensity, with different thresholds for significant disease
JF  - Translational Andrology and Urology; Vol 7, No 1 (February 23, 2018): Translational Andrology and Urology (Prostate Cancer Screening and Active Surveillance in the Western World)
Y2  - 2018
KW  - 
N2  - Background: The fear of undergrading prostate cancer (PCa) in men on active surveillance (AS) have led to strict criteria for monitoring, which have resulted in good long-term cancer-specific survival, proving the safety of this approach. Reducing undergrading, MRI-targeted biopsies are increasingly used in men with low-risk disease despite their undefined role yet. The objective of this study is to investigate the rate of upgrading using MRI-targeted biopsies in men with low-risk disease on AS, stratified on the basis of PIRADS and PSA-density, with the aim to reduce potential unnecessary repeat biopsy procedures.   Methods: A total of 331 men were prospectively enrolled following the MRI-PRIAS protocol. MR imaging was according to Prostate Imaging Reporting and Data System (PI-RADSv2) guidelines. Suspicious MRI lesions (PI-RADS 3–5) were additionally targeted by MRI-TRUS fusion biopsies. Outcome measure was upgrading to Gleason score (GS) ≥3+4 with MRI-targeted biopsies, stratified for PI-RADS and PSA-density.   Results: In total, 25% (82/331) of men on AS showed upgrading from GS 3+3. Only 3% (11/331) was upgraded to GS ≥8. In 60% (198/331) a suspicious MRI lesion was identified, but in only 41% (82/198) of men upgrading was confirmed. PI-RADS 3, 4 and 5 categorized index lesions, showed upgrading in 30%, 34% and 66% of men, respectively. Stratification to PI-RADS 4–5, instead of PI-RADS 3–5, would have missed a small number of high volume Gleason 4 PCa in PI-RADS 3 category. However, further stratification into PI-RADS 3 lesions and PSA-density 
UR  - https://tau.amegroups.org/article/view/18065