The Use of Multiparametric Magnetic Resonance Imaging for Follow-up of Patients Included in Active Surveillance Protocol. Can PSA Density Discriminate Patients at Different Risk of Reclassification?

Abstract Objectives To test PI-RADS classification on multiparametric Magnetic Resonance Imaging (mpMRI) and MRI-derived PSAD in predicting the risk of reclassification in men in Active Surveillance (AS), who underwent confirmatory or per-protocol follow-up biopsy. Materials and methods Three hundred eighty-nine patients in AS underwent mpMRI before confirmatory or follow-up biopsy. Patients with negative (-) mpMRI underwent systematic random biopsy. Patients with positive (+) mpMRI underwent targeted fusion prostate biopsies + systematic random biopsies. Different PSAD cut-off values were tested ( Results One hundred twenty-seven patients (32.6%) had mpMRI(-); 72 (18.5%) had PI-RADS 3, 150 (38.6%) PI-RADS 4, and 40 (10.3%) PI-RADS 5 lesions. The rate of reclassification to GG2 PCa was 16%, 22%, 31%, and 39% for mpMRI(-), PI-RADS 3, 4, and 5, respectively, in case of PSAD 0.20 ng/mL2 (p=0.007;OR:2.45), PIRADS 3 (p=0.013;OR:2.47), PIRADS 4 (p Conclusion PSAD ≥0.20 ng/mL2 may improve predictive accuracy of mpMRI results for reclassification of patients in AS, while PSAD