Diagnostic accuracy of mpMRI (multiparametric magnetic resonance imaging) in the diagnosis of clinically significant prostate cancer (csPCa) has been evaluated and compared with transperineal saturation prostate biopsy (SPBx).
From January 2011 to Febraury 2018 1032 men (median age 63 years) with median PSA of 8.6 ng/ml underwent repeat SPBx (reference test) for the suspicion of cancer. All the patients underwent 3.0 Tesla pelvic mpMRI before SPBx and the lesions with PI-RADS (Prostate Imaging-Reporting and Data System) score ≥ 3 were submitted to additional targeted fusion prostate biopsy (TPBx).
A T1c PCa was found in 372/1032 (36%) patients and 272 (73.1%) of them were classified as csPCa. SPBx vs. TPBx PI-RADS > 3 vs. TPBx PI-RADS > 4 diagnosed 95.6 vs. 83.8 vs. 60.3% (p < 0.0001) of the csPCa; in detail, SPBx missed 12/272 (4.5%) csPCa vs. 44/272 (16.2%) and 108/272 (39.7%) missed by TPBx PI-RADS > 3 and TPBx PI-RADS > 4 (p < 0.0001), respectively. The use of mpMRI as "a triage test" would have spared 49.3% vs. 73.6% using as cut-off a PI-RADS > 3 vs PI-RADS > 4, respectively.
MpMRI could significantly reduce the number of unnecessary repeat prostate biopsies (about 50% of the cases using a PI-RADS score > 3); at the same time, the patients should be informed of the false-negative rate for csPCa of TPBx for PI-RADS > 3 (16.2%) or > 4 (39.7%).
The Journal of urology. 2018 Apr 18 [Epub ahead of print]
Pietro Pepe, Antonio Garufi, Gian Domenico Priolo, Antonio Galia, Filippo Fraggetta, Michele Pennisi
Urology Unit. Electronic address: ., Imaging Department., Pathology Unit, Cannizzaro Hospital, Catania, Italy., Urology Unit.