PURPOSE: To evaluate the usefuleness of prebiopsy multiparametric MRI and clinical variables to reduce initial prostate biopsy.
MATERIALS AND METHODS: We prospectively evaluated 351 consecutive men with PSA levels between 2.5 and 20 ng/ml and/or DRE suspicious for clinically localized disease. All men underwent prebiopsy multiparametric MRI and an initial 14-29 core biopsy, including anterior samplings. Three definitions of significant cancer were defined based on Gleason score and cancer volume (percent positive core and/or maximum cancer length).Overall cohort was divided into low-risk (PSA < 10 ng/ml and a normal DRE) and high-risk group (PSA ≥10 ng/ml and/or an abnormal DRE). Frequency of significant cancer was evaluated according to MRI and risk categories. Clinical variables as predictors for significant cancer were analyzed using logistic regression. Sensitivity, specificity, PPV and NPV of MRI with or without clinical variables for significant cancer were calculated.
RESULTS: Frequency of significant cancer in men with negative or positive MRI was 9-13% or 43-50% in the low-risk, respectively and 47-51% or 68-71% in the high risk group, respectively. In men with negative MRI in the low-risk group, prostate volume was the only significant predictor of significant cancer. In the low-risk group, negative predictive value of a combination of positive MRI and lower prostate volume (< 33ml) for significant cancer was 93.7-97.5%.
CONCLUSIONS: Prebiopsy multiparametric MRI along with prostate volume has a high performance to reduce initial prostate biopsies by discriminating between significant cancer and others in men with PSA < 10 ng/ml and a normal DRE.
Written by:
Numao N, Yoshida S, Komai Y, Ishii C, Kagawa M, Kijima T, Yokoyama M, Ishioka J, Matsuoka Y, Koga F, Saito K, Masuda H, Fujii Y, Kawakami S, Kihara K. Are you the author?
Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
Reference: J Urol. 2013 Mar 6. pii: S0022-5347(13)03529-5.
doi: 10.1016/j.juro.2013.02.3197
PubMed Abstract
PMID: 23473904
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