Summary: New research from Michigan-based Corewell Health suggests that MRI scans can help predict the aggressiveness of intermediate-risk prostate cancer, guiding decisions between immediate treatment and active surveillance.

Key Takeaways

  • MRI scans can help predict the aggressiveness of intermediate-risk prostate cancer, aiding in treatment decisions between immediate intervention and active surveillance.
  • Patients with high-risk MRI features are about 130% more likely to develop more aggressive prostate cancer within five years compared to those with low-risk imaging results.
  • Suspicious MRI lesions significantly increase the risk of disease progression in both low- and intermediate-risk prostate cancer patients, underscoring the importance of upfront MRI before starting active surveillance.

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New research from Michigan-based Corewell Health suggests that MRI scans could help predict the aggressiveness of intermediate-risk prostate cancer, confined to the entire prostate, over a five-year period. This insight could guide doctors in deciding whether immediate treatment is necessary or if active surveillance, where the disease is closely monitored, is sufficient. The study, published in the Journal of Urology, is the first to focus on this risk group.

Differentiating Prostate Cancer Treatment

Active surveillance has become more common for managing low-risk prostate cancer, where less than half of one prostate lobe is affected and the cancer cells show minimal change. However, determining the best treatment for intermediate-risk patients remains more complex.

“While active surveillance is the standard of care for low-risk patients, it’s been unclear whether patients with a slower-growing form of intermediate-risk prostate cancer should be carefully watched or undergo immediate treatment,” says Kiran Nandalur, MD, principal investigator of the study and a radiologist at Corewell Health William Beaumont University Hospital. “Our data suggests that an MRI can show suspicious lesions based on size and markers of tumor aggression, which may help doctors differentiate a treatment path for these patients.”

In the study, about 1,500 low- and intermediate-risk patients across Michigan were examined to determine if individuals with suspicious findings on an MRI test returned with a more advanced stage of the disease within five years. Here’s what the study found:

  • Overall, 36% of the study participants who were watching their prostate cancer demonstrated more aggressive disease within five years.
  • Considering traditional risk factors and using an MRI classification system that rates lesion suspicion, patients with high-risk imaging features were approximately 130% more likely to have more aggressive disease on follow-up than those with low-risk imaging results.
  • Suspicious lesions on an MRI indicated more than twice the risk of progressive disease in both low-risk and intermediate-risk prostate cancer patients, which has not been previously shown in the intermediate-risk patients.

“The implication for patients and doctors is that an upfront MRI is important before undertaking any active surveillance for prostate cancer since it may help predict if an individual might come back with worse disease later,” Nandalur says. “This type of imaging helps pave the way for treatment planning so patients can live their lives to the fullest whether they decide to watch their cancer or seek treatment.”