ISSN 1305-3825 | E-ISSN 1305-3612
Abdominal Imaging - Original Article
Natural history of small index lesions suspicious for prostate cancer on multiparametric MRI: recommendations for interval imaging follow-up
1 Center for Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.  
2 Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA  
3 Urologic Oncology Branc, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA  
4 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA  
5 Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, Maryland, USA  
Diagn Interv Radiol 2014; 20: 293-298
DOI: 10.5152/dir.2014.13319
Abstract

PURPOSE

We aimed to determine the natural history of small index lesions identified on multiparametric-magnetic resonance imaging (MP-MRI) of the prostate by evaluating lesion-specific pathology and growth on serial MP-MRI.

 

MATERIALS AND METHODS

We performed a retrospective review of 153 patients who underwent a minimum of two MP-MRI sessions, on an institutional review board-approved protocol. Index lesion is defined as the lesion(s) with the highest cancer suspicion score based on initial MP-MRI of a patient, irrespective of size. Two study cohorts were identified: (1) patients with no index lesion or index lesion(s) ≤7 mm and (2) a subset with no index lesion or index lesion(s) ≤5 mm. Pathological analysis of the index lesions was performed following magnetic resonance/ultrasound fusion-guided biopsy. Growth rate of the lesions was calculated based on MP-MRI follow-up.

 

RESULTS

Patients with small index lesions measuring ≤7 mm (n=42) or a subset with lesions ≤5 mm (n=20) demonstrated either benign findings (86.2% and 87.5%, respectively) or low grade Gleason 6 prostate cancer (13.8% and 12.5%, respectively) on lesion-specific targeted biopsies. These lesions demonstrated no significant change in size (P = 0.93 and P = 0.36) over a mean imaging period of 2.31±1.56 years and 2.40±1.77 years for ≤7 mm and ≤5 mm index lesion thresholds, respectively. These findings held true on subset analyses of patients who had a minimum of two-year interval follow-up with MP-MRI.

 

CONCLUSION

Small index lesions of the prostate are pathologically benign lesions or occasionally low-grade cancers. Slow growth rate of these small index lesions on serial MP-MRI suggests a surveillance interval of at least two years without significant change.

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