MR, prostate cancer and active surveillance

Knowledge, or information, is power, and it can lead healthcare providers toward that über critical and elusive goal—value.

The concept of value and prostate cancer treatment can be at odds, particularly when men with indolent disease are referred for treatment. An active surveillance strategy can provide a valuable alternative, helping patients avoid treatment-associated morbidity and reducing overall healthcare costs. The approach is attracting increasing attention in the ongoing national healthcare debate.

However, current clinical identification scoring systems for determining which patients are candidates for active surveillance deliver variable accuracy, according to a study published online March 6 in Radiology.

Baris Turkbey, MD, from the molecular imaging program at the National Cancer Institute, National Institutes of Health in Bethesda, Md., and colleagues designed a retrospective analysis to determine whether multiparametric MRI can help identify active surveillance candidates. The researchers addressed MR independently and in conjunction with existing scoring systems.

Multiparametric MRI delivered a sensitivity of 93 percent for identifying active surveillance candidates and improved the sensitivity of other scoring systems when used in conjunction with them.

MR-informed decision making may be particularly valuable for African-American men and may help set the stage for a more personalized approach to active surveillance and treatment. A study published in the March issue of Urology indicated that African-American men with prostate cancer initially classified as low risk were found to have advanced cancer at prostatectomy at a rate nearly twice that of Caucasian men.

Given previous research showing more aggressive disease biomarkers in African American men, “the results of the present study suggest that the commonly used [active surveillance] strategies have a significant risk of cancer misclassification and [active surveillance] may not be as safe a treatment modality for many [African-American] patients with [prostate cancer],” wrote Isaac Yi Kim, MD, PhD, of the Cancer Institute of New Jersey in New Brunswick, and colleagues. Could multiparametric MR provide value in this population? The question has not been answered, but the possibility certainly exists.

How is your practice using MR data to improve value and drive decisions? Please let us know.

Lisa Fratt, editor