Multi-parametric Magnetic Resonans Imaging in the Diagnosis and Surveillance of Low-risk Prostate Cancer

At the urological department K, Aarhus University Hospital (AUH), approx. 500 TRUS biopsies are performed each year and about 125 intermediate/high risk patients undergo radical prostatectomy (RP). At any time approx. 50 men with low-risk PC is in active surveillance (AS).

The MRIs will all be performed with a 3 Tesla MRI system with a phased-array coil including standard T1 and T2-weighted sequences, diffusion-weighted sequences with different b-values and a dynamic contrast sequence of the prostate gland. In patients in whom a previous mMRI has shown tumor, the MRGBs will be performed with the commercially available DynaCAD-equipment designed for in-bore MR-guided prostate biopsies.

The Study Design: a prospective study of 60* patients enrolled in an AS program. From late 2014 and approximately one year forward, all patients put in active surveillance after the diagnosis of low risk PC, will after that decision be offered an additional mMRI scan.

If the mMRI gives rise to suspicion of significant cancer, MRGB will be taken. Results of these biopsies will be assessed, and in some cases gleason score will be up-grated, risk classification will be up-grated and the decision to keep the patient in AS will have to be changed, and active treatment will be recommended. If the scan finds no reason to change strategy, the patient will have the usual follow-ups in the clinic, which in an AS program usually consists of control PSA value every 3 months, and new TRUS guided biopsies after 12 months or if PSA rises. Parallel to the usual control program we will perform a new mMRI once a year to assess if there is any progression in the disease, and again do MRGB if this is the case.

The study will require access to the patient journals. We will look at patient demographics, specification on the PC found, histology and blood samples.