To assess the accuracy of multiparametric magnetic resonance imaging (mpMRI) for significant PC detection before diagnostic biopsy in men with abnormal PSA/DRE.
388 men underwent mpMRI including T2-weighted, diffusion-weighted & dynamic contrast-enhanced imaging prior to biopsy.
Two radiologists used PIRADS reporting system to allocate a score of 1-5 for suspicion of significant PC (Gleason 7 with >5% grade 4). PIRADS score 3-5 was considered positive. Transperineal template-guided mapping biopsy of 18-regions (median 30 cores) were performed, with additional manually directed cores from MRI-positive regions. The anatomical location, size, and grade of individual cancer areas in the 18-biopsy regions, as primary outcome, and in prostatectomy specimens (n=117), as secondary outcome, were correlated to the MRI-positive regions.
Of the 388 men that were enrolled, 344 were analyzed. mpMRI was positive in 77. 0% of patients, 62. 5% had PC and 41. 6% had significant PC. Detection of significant PC by mpMRI had sensitivity of 96%, specificity of 36%, NPV and PPV were 92% and 52%. Adding PIRADS to the multivariate model including PSA, DRE, prostate volume and age improved the AUC from 0. 776 to 0. 879, p
In men with abnormal PSA/DRE, mpMRI detected significant PC with an excellent NPV and moderate PPV. The use of mpMRI for diagnosing significant PC may result in a substantial number of unnecessary biopsies while missing minimum number of significant PC.
The Journal of urology. 2015 Oct 31 [Epub ahead of print]
J E Thompson, P J van Leeuwen, D Moses, R Shnier, P Brenner, W Delprado, M Pulbrook, M Böhm, A M Haynes, A Hayen, P D Stricker
St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , University of Notre Dame, Darlinghurst, New South Wales, Australia. , Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia. , Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia. , Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia. , School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales, Australia. , St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.