By: Dan Sperling, MD
This year’s annual meeting of the American Urological Association (Orlando, FL) brought numerous papers and presentations on multiparametric MRI (3T mpMRI) of the prostate. I interpret this to mean that the value of radiologic imaging for the detection, diagnosis and guided treatment of prostate cancer has gained considerable—perhaps even definitive—recognition by urologists.
I have written before about the importance of teamwork among medical specialties. Nowhere is this more evident than between urologists and radiologists as we improve and broaden clinical choices for prostate cancer patients. For example, targeted biopsies can be done under real-time MRI guidance, as we do at our center, but for locations where patients don’t yet have access to 3T mpMRI, new software technologies for “fusing” MRI and real-time ultrasound literally merge radiologic and urologic imaging in a way that urologists can make use of in their own practices.
However, there are some areas in which 3T mpMRI is superior to, and likely to end, traditional urologic tools. One of these concerns predicting a patient’s risk level of prostate cancer in order to plan treatment; for instance, less aggressive disease may be compatible with a wider range of options, including Active Surveillance, than more aggressive cancer. The ability to determine in advance whether the cancer is still confined to the gland would help avoid the problem of under-treating dangerous cancer and possibly behind disease that has already penetrated the prostate capsule, or over-treating low risk cancer but possibly impairing lifestyle.
Traditionally, after the biopsy results come in, urologists have relied on a probability algorithm called the Partin tables to anticipate the likelihood that prostate cancer is still organ confined (OC) at the time of treatment. These tables take into account a patient’s clinical factors of PSA, Gleason grade, and stage of disease. In other words, the tables are a sort of informed probability that varies with each patient’s numbers.
One of the presentations at the AUA meeting compared the predictive accuracy of the Partin tables with mpMRI when it comes to organ-confined prostate cancer.[i] Based on 60 patients who had 3T mpMRI in addition to calculated risk level according to the Partin tables, the authors found that “the predictive accuracy of mp-MRI in predicting OC disease at pathological analysis significantly improves upon that of the Partin tables.” They recommend that mp-MRI should be considered when planning prostate cancer treatment.
In our view, the Partin tables have provided a very good service in helping discern best treatment choices in their day. However, a new day has dawned with the coming of 3T mpMRI, and we are proud to offer this essential imaging to patients so they and their doctors can make a better-informed treatment plan.
[i] Passoni N, Gupta R, Kaurrman C, Kirema GR, Polascik T. Comparison of the predictive accuracy of the Partin Tables vs multi-parametric MRI in forecasting organ-confined prostate cancer. 2014 Annual Meeting of the American Urological Association (Orlando, FL May 16-21).