The Impact of MRI on Treatment of Newly Diagnosed Grade Group 1 Prostate Cancer

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

NTRODUCTION AND OBJECTIVES: Active surveillance (AS )has become the standard of care for men with clinical Gleason grade group 1 (GG1) prostate cancer (PCa). The aim of this study was to evaluate the effect of MRI on type of treatment for men with GG1 PCa. METHODS: The Michigan Urological Surgical Improvement Collaborative (MUSIC) Prostate Database was retrospectively reviewed. We identified patients with GG1 on initial prostate biopsy between 2021 and 2024. Our outcome variable was treatment type at 6 months from diagnosis. A multivariable logistic regression model was used to predict the selection of treatment (versus AS). The key independent variable was MRI (non-reassuring, reassuring, none available)performed within ± 6 months of diagnosing biopsy. A PI-RADS 4 or 5 lesion was considered non-reassuring. The model controlled for genomic testing, prostate volume, PSA density, BMI, Charlson Comorbidity Index, clinical T-stage, age, race and family history. RESULTS: 5486 patients were diagnosed with GG1 between 2021 and 2024. Active surveillance was selected for 90% (4932/5486) of patients. Of patients treated, 67% (370/554) had radical prostatectomy, 30% (164/554) had radiation and 3% (20/554) had cryoablation.34% (1838/5486) had an MRI, of which 67% (1225/1838) and 33%(613/1838) were non-reassuring and reassuring, respectively. 11% (140/1225) with a non-reassuring MRI underwent definitive treatment, compared to 7% (45/613) with a reassuring MRI. In the regression model, a non-reassuring MRI (compared to patients without an MRI) was associated with definitive treatment (OR 1.5, CI 1.1-1.8, p=0.002). Meanwhile, a reassuring genomic test (compared to patients without a genomic test) was associated with selection of AS (OR 0.44, CI 0.2-0.8, p=0.007) (Table). CONCLUSIONS: In men with clinical GG1 PCa, those with a non-reassuring MRI were more likely to select definitive treatment. Further studies investigating prognostic value of MRI in patients with clinical GG1 are warranted.

Volume

215

Issue

5S

First Page

e1590

Last Page

e1590

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191764.50307.1e.13

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