Magnetic resonance imaging and spectroscopy findings, in combination with clinical variables and biopsy data, may be useful for predicting insignificant prostate cancer, according to an initial study. Magnetic resonance imaging and spectroscopy findings, in combination with clinical variables and biopsy data, may be useful for predicting insignificant prostate cancer, according to an initial study reported in the April issue of BJU International.

"The increasing incidence of small-volume, low-grade cancers on pathology in PSA-screened populations and the slow natural history of prostate cancer have raised concerns that some patients with clinically insignificant cancers are being over-treated," the authors note.

The study involved 220 prostate cancer patients who underwent magnetic resonance imaging (MRI) and MR spectroscopy imaging (MRSI) before radical prostatectomy. They had clinical stage T1c or T2a prostate cancer, PSA levels < 20 ng/mL and Gleason scores of 6.

Dr. Amita Shukla-Dave from Memorial Sloan-Kettering Cancer Center, New York, and colleagues recorded the probability of insignificant cancer retrospectively and separately for MRI and combined MRI/MRSI.

At pathology, 41 per cent of patients had insignificant cancer defined as organ-confined cancer measuring 0.5 cubic centimeters or less with no poorly differentiated elements, the investigators found.

Both MRI and combined MRI/MRSI models developed by the team incorporating clinical, biopsy, and MR data, performed "significantly better" than existing clinical models in predicting insignificant cancer, they report.

After appropriate validation, the new MRI and MRI/MRSI models might improve the overall accuracy of clinical models in predicting the likelihood of insignificant prostate cancer and help in counseling patients who are considering deferred therapy, Dr. Shukla-Dave and colleagues conclude.

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