JU INSIGHT MRI Predicts Cancer Risk of High-Grade Prostatic Intraepithelial Neoplasia and Atypical Small Acinar Proliferation

By: Michael S. Sessine, MD, Wayne State University, Detroit, Michigan; Codrut S. Radoiu, BMSc, Wayne State University, Detroit, Michigan; Ji Qi, PhD, University of Michigan, Ann Arbor; Corinne Labardee, MPH, University of Michigan, Ann Arbor; Frank Burks, MD, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; Arvin K. George, MD, University of Michigan, Ann Arbor, Johns Hopkins School of Medicine, Baltimore, Maryland; Brian R. Lane, MD, Corewell Health, Grand Rapids, Michigan; Kenneth Lim, DO, Detroit Medical Center, Michigan; Ali Dabaja, MD, Henry Ford Health System, Detroit, Michigan; Todd M. Morgan, MD, University of Michigan, Ann Arbor; Michael L. Cher, MD, Wayne State University, Detroit, Michigan; Alice M. Semerjian, MD, University of Michigan, Ann Arbor, St Joseph Mercy Hospital, Ann Arbor, Michigan; Kevin B. Ginsburg, MD, Wayne State University, Detroit, Michigan For the Michigan Urological Surgery Improvement Collaborative (MUSIC) | Posted on: 21 Feb 2024

Sessine MS, Radoiu CS, Qi J, et al. 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?. J Urol. 2024;211(2):234-240.

Study Need and Importance

Patients with a diagnosis of multifocal high-grade intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) are currently recommended to undergo further risk stratification with a repeat biopsy, MRI, and/or biomarkers. Despite these recommendations, data to support the use of MRI in this setting are limited. Thus, our study aimed to investigate the potential utility of MRI for adjudicating which patients should undergo repeat biopsy after a diagnosis of multifocal HGPIN and/or ASAP.

What We Found

We found that on repeat biopsy after a diagnosis of multifocal HGPIN and/or ASAP, a lower proportion of men with Prostate Imaging–Reporting and Data System (PIRADS) ≤ 3 lesions had ≥ Gleason Grade (GG) 2 (3.0%) prostate cancer (CaP) compared to men without an MRI (12% ≥GG2, P = .13). Men with a PIRADS ≥ 4 lesion after the initial biopsy had a higher proportion of ≥ GG2 (56%) CaP compared to men without an MRI (12% ≥GG2, P < .001; Table). In our multivariable model, men with a PIRADS 4 to 5 lesion had higher odds (OR: 11.4, P < .001) of ≥ GG2 CaP on repeat biopsy.

Table. Proportion of Men With Clinically Significant Prostate Cancer on Repeat Biopsy After a Diagnosis of Multifocal High-Grade Intraepithelial Neoplasia or Atypical Small Acinar Proliferation Among Men With PIRADS 1 to 3, No MRI, and PIRADS 4 to 5 Lesions

	PIRADS ≤3 (95% CI)	No MRI (95% CI)	PIRADS ≥4 (95% CI)	P value
Clinically significant prostate cancer	3.1% (0%-16%)	12% (7%-19%)	56% (40%-71%)	< .001
Abbreviations: PIRADS, Prostate Imaging–Reporting and Data System. Proportions were compared with the χ² test.

Limitations

Our study is limited by being a retrospective review with a limited sample size and no central pathology or radiology review. However, the strength of the Michigan Urological Surgery Improvement Collaborative cohort is that it is multicenter and contains a mix of academic and private sites. Furthermore, while prostate MRI use is growing, these patients undergoing repeat biopsy, or even an MRI, may represent a higher-risk cohort with a higher level of clinical concern prompting further workup.

Interpretation for Patient Care

MRI may be utilized to inform which patients with a diagnosis of multifocal HGPIN and/or ASAP can safely forgo a repeat biopsy. Thus, by using prostate MRI to help risk stratify patients with multifocal HGPIN and/or ASAP, we may be able to greatly reduce the burden of unnecessary prostate biopsies, while missing very few men with clinically significant disease.