New research argues for MRI in all prostate cancer patients, even those considered low-risk
MR imaging of patients with intermediate-risk prostate cancer could guide providers in determining whether cancer will progress into more aggressive disease down the road, new research suggests.
Not all men who are diagnosed with low or intermediate risk prostate cancer complete MRI exams to determine the extent of their disease. Often, men in these groups opt for active surveillance in lieu of surgery or radiation therapy as well.
However, new research indicates that obtaining an MRI at the time of a patient’s initial diagnosis may provide important insight into how cancer will progress over time. Of the men included in the research, all of whom had low or intermediate risk cancer and underwent MRI, nearly 40% went on to develop more aggressive disease within five years of their diagnosis. Many had suspicious imaging findings at the time.
The study's findings could have important clinical implications for how prostate cancer is managed in the future, authors involved in the work suggested.
“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,” principal investigator Kiran Nandalur, MD, a radiologist at Corewell Health William Beaumont University Hospital, said in a release. “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.”
Many men in the low and intermediate risk groups choose to go the active surveillance route to avoid some of the unpleasant side effects associated with radiation therapy and surgery. In these instances, cancer is confined to half of one lobe of the prostate and does not display signs of mutation.
However, foregoing treatment, even in low-risk groups, puts patients at risk of disease spread.
Approximately 1,500 men with low or intermediate risk prostate cancer were included in this latest analysis. Based on prostate MRI lesion classification standards, those who had lesions considered high-risk were 130% more likely to develop aggressive cancer within five years compared to those with low-risk features. However, in both low and intermediate risk groups, suspicious lesions in general were linked to double the odds of cancer progression during the study period.
These findings highlight the importance of obtaining MRI following a prostate cancer diagnosis, even in those with cancer considered low-risk, Nandalur noted.
“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 said. “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.”
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.