Can MRI Help Inform Which Men With a History of Multifocal High-Grade Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation Remain at an Elevated Risk for Clinically Significant Prostate Cancer?

Purpose: We investigated the association of MRI findings in men with a previous diagnosis of atypical small acinar proliferation (ASAP) or multifocal high-grade intraepithelial neoplasia (HGPIN) with pathologic findings on repeat biopsy.Materials and methods: We retrospectively reviewed patients with ASAP/multifocal HGPIN undergoing a repeat biopsy in the Michigan Urological Surgery Improvement Collaborative registry. We included men with and without an MRI after the index biopsy demonstrating ASAP/multifocal HGPIN but before the repeat biopsy. Men with an MRI prior to the index biopsy were excluded. We compared the proportion of men with >= GG2 CaP (Grade Group 2 prostate cancer) on repeat biopsy among the following groups with the chi(2) test: no MRI, PIRADS (Prostate Imaging-Reporting and Data System) >= 4, and PIRADS <= 3. Multivariable models were used to estimate the adjusted association between MRI findings and >= GG2 CaP on repeat biopsy.Results: Among the 207 men with a previous diagnosis of ASAP/multifocal HGPIN that underwent a repeat biopsy, men with a PIRADS >= 4 lesion had a higher proportion of >= GG2 CaP (56%) compared with men without an MRI (12%, P < .001). A lower proportion of men with PIRADS <= 3 lesions had >= GG2 CaP (3.0%) compared with men without an MRI (12%, P = .13). In the adjusted model, men with a PIRADS 4 to 5 lesion had higher odds (OR: 11.4, P < .001) of >= GG2 CaP on repeat biopsy.Conclusions: MRI is a valuable diagnostic tool to triage which men with a history of ASAP or multifocal HGPIN on initial biopsy should undergo or avoid repeat biopsy without missing clinically significant CaP.