This presentation will review the utility of multiparametric MRI (mpMRI) and genomic testing in the management of early stage prostate cancer and show when and if such tests should be used alone or in combination.
Prostate cancer (PCa) is the second most frequently diagnosed male malignancy worldwide. In the United States, approximately over 174,000 men are diagnosed with PCa and 31,000 men die of the disease per year. The majority of PCa diagnosed, however, are low-risk indolent lesions which are not expected to increase disease-specific mortality. Despite evidence demonstrating the lack of prostate cancer specific-survival benefit in this population, many patients receive immediate curative therapy.
Recently, active surveillance (AS), which monitors patients for disease progression, has been included in the National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) guidelines and is increasingly utilized as a treatment option for low- and favorable intermediate-risk patients. Adoption of AS has been slow as current clinicopathological factors such as patient age, PSA, tumor grade (Gleason score) and tumor volume on biopsy do not adequately risk stratify patients.
Newer tools for patient risk stratification such as mpMRI and genomic tests have substantially improved risk stratification so that clinicians can better optimize treatment selection between AS and immediate therapy such as radical prostatectomy or radiation.