18 Background: Early-stage patients with prostate cancer can decide to go on Active Holistic Surveillance (AHS) to avoid over-treatment of a disease that has a high probability of being indolent. These patients are also placed on a special diet with vitamin supplements. We evaluate the imaging characteristics of this particular set of patients with prostate cancer with early-stage disease who are on a special diet and vitamin supplements, discontinued AHS and received definitive treatment. Methods: 300 consecutive 3T Multiparametric Prostate MRI (MP-MRI) were identified from March 26, 2012, to June 29, 2015. 200 patients (age 44 to 84 years) were identified in the active surveillance program. 114 patients had an initial MP-MRI prior to starting AHS and had at least one follow up MP-MRI after beginning AHS. 14 (12%) patients (age 60 to 79 years) discontinued AHS due to changes on a follow up MRI suggesting clinically significant prostate cancer. The MRI imaging findings were evaluated and correlated with pathology results, if available. Results: Of 14 patients, 3 (21%) patients had an enlarging MRI lesion compared to a previous MRI, 2 (14 %) patients had a new MRI lesion(s) suspicious for cancer, and 9 (64%) patients had suspicion or confirmation of extracapsular extension. 7 (50%) patients had a biopsy after a follow up MP-MRI with 6 (43%) demonstrating tumor upgrading. Length of time on AHS ranged from 4 months to 110 months. Prostate-specific antigen (PSA) levels and PSA density prior to beginning AHS ranged from 4.8 to 12.0 and 0.04 to 0.39, respectively. All were treated with definitive treatment, majority with unilateral focal cryoablation. Conclusions: The small number of patients with worsening disease on follow-up MP-MRI supports the role of AHS in patients with early-stage prostate cancer. MP-MRI is a useful tool in following patients on AHS and can extract patients who potentially may have clinically significant cancer and who may benefit from definitive treatment.
68Ga-PSMA PET/MR–Positive, Histopathology-Proven Prostate Cancer in a Patient With Negative Multiparametric Prostate MRI
