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EAU 2018

EAU 2018: Prediction of Significant Prostate Cancer in Patients with Previously Negative Prostate Biopsy Undergoing MRI/Ultrasound-Fusion Biopsy in Combination with Systematic Biopsy

Copenhagen, Denmark (UroToday.com) Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy has become an established diagnostic tool in patients with suspected prostate cancer (PCa). The authors presented a study comparing transperineal MRI/ultrasound-fusion biopsy (fusPbx) to transrectal systematic biopsy (sysPbx) in patients with previously negative biopsy. Furthermore, they investigated the prediction of significant PCa by clinical parameters in patients presenting with maximum PI-RADS 3 lesions (maxPI-RADS ≤3).

Patients underwent mpMRI and lesions detected in mpMRI were classified according to PI-RADS. Significant PCa was defined as a Gleason score ≥7(3+4). Logistic regression analysis was performed to evaluate mpMRI and clinical parameters for the prediction of significant PCa.

Overall 710 patients were included. 46% (n=329) of those presented a maxPI-RADS ≤3. The detection rate of significant PCa was 32% (226/710) for fusPbx and 23% (165/710) for sysPbx (p<0.005). Overall, the missing rate of significant PCa was 15% (39/262) in fusPbx and 38% (100/262) in sysPbx. In multivariable analysis, the strongest independent predictors for significant PCa were:

  1. High PSA-value (≥median PSA of 8.8ng/mL; OR 2.6 95%-CI 1.7-3.9; p<0.005), 
  2. Rising age (≥median age of 67years; OR 2.3 95%-CI 1.6-3.3; p<0.005) 
  3. Evidence of at least one PI-RADS≥4 lesion (OR 2.2 95%-CI 1.5-3.2; p<0.005). 
Detection rate of significant PCa in patients with maxPI-RADS ≤3 was 22% (72/329). Patients with maxPI-RADS ≤3 and a PSA-density ≥0.2ng/mL2 harboured more significant PCa than those with a PSA-density <0.2ng/mL2 (36% (29/81) vs. 17% (43/248); p<0.001).

In conclusion, the missing rate of significant PCa was still high in fusPbx. Despite harboring low-suspicious lesions in mpMRI, patients showed a high-detection rate of significant PCa. Of those, patients with a high PSA-density level harboured a high rate of significant PCa. For these patients, high PSA-density level should be considered as an indicator for significant PCa.


Presented by: Borkowetz A,  Technische Universität Dresden, Dept. of Urology, Dresden, Germany

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark