PURPOSE: To determine the utility of multiparametric-MRI (MP-MRI) in detecting prostate cancer (PCa), with specific focus on detecting higher-grade PCa.
MATERIALS AND METHODS: Prospectively, 583 patients who underwent MP-MRI and subsequent prostate biopsy at a single institution were evaluated. On MP-MRI, lesions were identified and scored as low, moderate, or high suspicion for PCa based upon a validated scoring system. MR/US fusion-guided biopsies of MRI lesions in addition to systematic 12-core biopsies were performed. Correlations between the highest assigned MP-MRI suspicion score and presence of cancer and biopsy Gleason Score (bGS) on the first fusion biopsy session were assessed using univariate and multivariable logistic regression models. Sensitivity, specificity, NPV, and PPV were calculated and ROC curves were developed to assess the discriminative ability of MP-MRI as a diagnostic tool for various bGS cohorts.
RESULTS: Significant correlations were found between age, PSA, prostate volume, and MP-MRI suspicion score and the presence of PCa (p< 0.0001). On multivariable analyses controlling for age, PSA, and prostate volume, increasing MP-MRI suspicion was an independent prognosticator of PCa detection (OR=2.2, p< 0.0001). Also, incremental increases in MP-MRI suspicion score demonstrated stronger associations with cancer detection in patients with Gleason ≥7 (OR=3.3, p< 0.001) and Gleason ≥8 (OR=4.2, p< 0.0001) PCa. Assessing MP-MRI as a diagnostic tool for all PCa, bGS≥7, and bGS≥8 separately via ROC analyses demonstrated increasing accuracy of MP-MRI for higher-grade disease (AUC=0.64, 0.69, and 0.72, respectively).
CONCLUSIONS: MP-MRI is a clinically useful modality to detect and characterize PCa, particularly in men with higher-grade disease.
Written by:
Rais-Bahrami S, Siddiqui MM, Turkbey B, Stamatakis L, Logan J, Hoang AN, Walton-Diaz A, Vourganti S, Truong H, Kruecker J, Merino MJ, Wood BJ, Choyke PL, Pinto PA. Are you the author?
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health.
Reference: J Urol. 2013 May 29. pii: S0022-5347(13)04417-0.
doi: 10.1016/j.juro.2013.05.052
PubMed Abstract
PMID: 23727310
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