A new study from Michigan-based Corewell Health suggests that MR can help predict whether patients with intermediate-risk prostate cancer may develop more aggressive cancer within five years, helping to determine whether immediate treatment is necessary.

Traditionally, low-risk prostate cancer patients — those with less than half of one lobe affected — are managed with active surveillance to avoid the side effects of surgery or radiation. However, determining the appropriate treatment for intermediate-risk patients has been more challenging. The research, published in the Journal of Urology, is the first to focus on intermediate-risk prostate cancer patients, which is by definition confined to the prostate without significant mutation or change in the cells.

“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,” said Dr. Kiran Nandalur, the study's principal investigator and a radiologist at Corewell Health William Beaumont University Hospital. “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.”
The study examined about 1,500 low- and intermediate-risk patients across Michigan to evaluate if suspicious MR findings correlated with more advanced disease within five years. Key findings include:

• 36% of participants under active surveillance developed more aggressive disease within five years.
• Patients with high-risk imaging features were 130% more likely to progress to aggressive disease than those with low-risk features.
• Suspicious MRI lesions indicated more than double the risk of disease progression in both low- and intermediate-risk patients.

“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,” Dr. 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.”

Collaborating institutions on the study include the Department of Urology at Wayne State University, the Michigan Institute of Urology, the Brady Urologic Institute at Johns Hopkins University, and the Michigan Urological Surgery Improvement Collaborative.

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