SIU 2017: Transperineal Template-Guided Mapping Biopsy and Multiparametric MRI for Detection of Clinically Significant Prostate Cancer in Patients after initial Negative Trans-rectal Ultrasound-Guided Biopsy

Lisbon, Portugal ( Rising PSA after initial negative prostate biopsy is a dilemma in daily urological practice. In the past years multiparametric MRI (mpMRI) has been used to stratify patient risk of having clinically significant prostate cancer (PCa) and is helpful in preventing unnecessary prostate biopsy. The aim of this study was to evaluate the significance of mpMRI on detecting prostate cancer on repeat biopsy when transperineal prostate mapping (TPM) technique is applied.

Prospective clinical data of 72 patients with prior negative prostate biopsy and rising PSA level were collected. All patients underwent 1.5T mpMRI with subsequent 20 core transperineal prostate biopsy. Radiological examination was performed according to PIRADS 2.0 version. Radiologist scores and location were matched with TPM histopathology of the prostate. The positive (PPV) and negative (NPV) predictive values of mpMRI for ruling out any PCa and clinical significant PCa were calculated.

PCa was detected in 37 (51.4%) and clinically significant PCa in 24 (33.3%) patients. Patient's median age at the time of TPM biopsy was (62.3+6.3), PSA (8.41+4.2) PSA density (0.203+0.18). Almost two thirds of patients underwent first repeat biopsy, 30.4% and 5.7% second and third repeat biopsy, respectively. Calculated PPV and NPV of mpMRI to detect PCa were 45.45% and 39.29% with specificity and sensitivity of 54.05% and 31.43% respectively. For clinically significant PCa, PPV and NPV of mpMRI were smaller and reached 27.08% and 57.14% respectively, with sensitivity of 59.09% and specificity of 25.53%.

The authors concluded that TPM biopsies detect prostate cancer in over half of the patients with one or more initially negative prostate biopsies and mpMRI is helpful in identifying prostate lesions suggestive of cancer.

Presented by: Vezelis A 
Affiliation: Nacional Cancer Institute, Vilnius, Lituania

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal