PURPOSE: MpMRI appears to improve PCa detection, but prospective studies are lacking.
Our objective was to determine the accuracy of mpMRI for detecting significant PCa prior to diagnostic biopsy in men with abnormal PSA/ DRE.
MATERIALS AND METHODS: Single center, prospective study. Men with age >40, abnormal PSA/DRE and no previous mpMRI, underwent T2WI, DWI and DCEI without endorectal coil, allocated alternately to 1.5T/ 3.0T. MpMRIs were double-reported independently using PIRADS, by specialist radiologists. Transperineal grid-directed 30-core biopsy was performed, with additional MRI-directed cores for ROIs outside template locations. Four significant cancer definitions were tested. Chi-square and logistic regression analysis were performed. Men undergoing prostatectomy were analyzed.
RESULTS: 165 men were enrolled, 150 analyzed (median age 62.4 years, PSA 5.6, 29% abnormal DRE, 88% first biopsy). 66% had positive mpMRI (PIRADS 3-5). 61% had PCa, 30-41% had significant PCa (definitions 1-4). Sensitivity, specificity, NPV & PPV for significant cancer was 93-96%, 47-53%, 92-96% and 43-57% respectively (definitions 1-4). RP results in 48 men were similar. Aggregate PIRADS (4-20) performed similarly to overall PIRADS (1-5). NPV (100%) and PPV (71%) were similar in higher risk men (PSA>10/ abnormal DRE). On multivariate analysis, PIRADS score was associated with significant PCa (p< 0.001); magnet strength was not. Adding PIRADS to the multivariate model improved AUC from 0.810 to 0.913 (p = 0.002, 95%CI 0.038-0.166; see figure 3). Radiologist agreement was substantial (weighted kappa = 0.626).
CONCLUSIONS: MpMRI reported by expert radiologists achieved an excellent NPV and moderate PPV for significant PCa, at both 1.5T and 3.0T.
Written by:
Thompson JE, Moses D2, Shnier R2, Brenner P1, Delprado W3, Ponsky L4, Pulbrook M5, Böhm M5, Haynes AM5, Hayen A6, Stricker PD. Are you the author?
St Vincent's Prostate Cancer Centre, Darlinghurst, NSW Australia; Garvan Institute of Medical Research & Kinghorn Cancer Centre, Darlinghurst, NSW Australia; School of Medicine, University of New South Wales, Kensington, NSW Australia; University of Notre Dame, Darlinghurst, NSW Australia; University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Ohio USA; School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW Australia.
Reference: J Urol. 2014 Feb 8. pii: S0022-5347(14)00025-1.
doi: 10.1016/j.juro.2014.01.014
PubMed Abstract
PMID: 24518762
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