Confirmatory MRI With or Without Biopsy Impacts Decision-Making in Newly Diagnosed Favorable Risk Prostate Cancer.

PURPOSE: To investigate how MRI and post-MRI biopsy (pMRI-Bx) impact decision-making in men considering active surveillance (AS).

MATERIALS AND METHODS: We reviewed men in the Michigan Urological Surgery Improvement Collaborative with newly diagnosed favorable risk prostate cancer. Following the diagnostic biopsy (dBx), men were classified into three groups: 1) no MRI, 2) MRI only, and 3) MRI/pMRI-Bx. For the purpose of counseling and shared decision-making, MRI results were deemed reassuring (RA) (PIRADS ≤3) or nonRA (PIRADS ≥4). Similarly, if the dBx was GG1, pMRI-Bx results were deemed nonRA if there was any amount of ≥GG2; if the dBx was GG2, pMRI-Bx results were deemed nonRA if >3 cores GG2, >50% GG2 in any individual core, or any volume of ≥GG3.

RESULTS: Of 1461 men with FRPC, 1223 men (84%) did not have a MRI, 157 (11%) men had a MRI alone, and 81 (6%) men had a MRI/pMRI-Bx. Of the men with a MRI alone, more men with a RA MRI (74%) chose AS compared with a nonRA MRI (35%) or men without a MRI (42%). The highest rate of AS occurred in men with a RA pMRI-Bx regardless of whether the MRI was RA or nonRA (93% and 96%, respectively).

CONCLUSION: MRI and pMRI-Bx drive decision-making in men with newly diagnosed favorable risk prostate cancer. pMRI-Bx is a stronger driver of decision-making than MRI alone as demonstrated by the high proportion (>90%) of men with a RA pMRI-Bx who chose AS regardless of MRI results.