OBJECTIVES: To determine the diagnostic yield of analyzing biparametric (T2 and diffusion-weighted) MRI (B-MRI) for prostate cancer detection compared to standard digital rectal exam and PSA-based screening.
PATIENTS AND METHODS: Review of patients who were enrolled in a trial to undergo MP-MRI and MR/US fusion-guided prostate biopsy at our institution identified 143 men who underwent MP-MRI in addition to standard DRE and PSA-based PCa screening prior to any prostate biopsy. Patient demographics, digital rectal exam staging, PSA, PSA density, and B-MRI findings were assessed for association with prostate cancer detection on biopsy.
RESULTS: Men with detected prostate cancer tended to be older, with higher PSA, higher PSA density, and increased number of screen positive lesions (#SPL) on B-MRI. B-MRI performed well for the detection of prostate cancer with an AUC of 0.80 (compared to 0.66 and 0.74 for PSA and PSA density). We derived combined PSA and MRI-based formulas for detection of prostate cancer with optimized thresholds. (1) for PSA and B-MRI: PSA + 6 x (#SPL) > 14 and (2) for PSA density and B-MRI: 14 x (PSA density) + (#SPL) >4.25. Area under the curve for equations 1 and 2 were 0.83 and 0.87 and overall accuracy of prostate cancer detection was 79% in both models.
CONCLUSION: Number of lesions positive on B-MRI outperforms PSA alone in detection of prostate cancer. Furthermore, this imaging criteria coupled as an adjunct with PSA and PSA density, provides even more accuracy in detecting clinically-significant prostate cancer.
Written by:
Rais-Bahrami S, Siddiqui MM, Vourganti S, Turkbey B, Rastinehad AR, Stamatakis L, Truong H, Walton-Diaz A, Hoang AN, Nix JW, Merino MJ, Wood BJ, Simon RM, Choyke PL, Pinto PA. Are you the author?
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health.
Reference: BJU Int. 2014 Jan 21. Epub ahead of print.
doi: 10.1111/bju.12639
PubMed Abstract
PMID: 24447678
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