Diagnostic Pathway with Multiparametric Magnetic Resonance Imaging Versus Standard Pathway: Results from a Randomized Prospective Study in Biopsy-naïve Patients with Suspected Prostate Cancer.

BACKGROUND: An approach based on multiparametric magnetic resonance imaging (mpMRI) might increase the detection rate (DR) of clinically significant prostate cancer (csPCa).

OBJECTIVE: To compare a mpMRI-based pathway with the standard approach for the detection of prostate cancer (PCa) and csPCa.

DESIGN, SETTING, AND PARTICIPANTS: Between November 2014 and April 2016, 212 biopsy-naïve patients with suspected PCa (prostate-specific antigen level ≤15 ng/ml and negative digital rectal examination results) were included in this randomized clinical trial. Patients were randomized into a prebiopsy mpMRI group (arm A, n=107) or a standard biopsy (SB) group (arm B, n=105).

INTERVENTION:
In arm A, patients with mpMRI evidence of lesions suspected for PCa underwent mpMRI/transrectal ultrasound fusion software-guided targeted biopsy (TB) (n=81). The remaining patients in arm A (n=26) with negative mpMRI results and patients in arm B underwent 12-core SB.

OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS:
The primary endpoint was the comparison of the DR of PCa and csPCa between the two arms of the study; the secondary endpoint was a comparison of the DR between TB and SB.

RESULTS AND LIMITATIONS:
The overall DRs were higher in arm A versus arm B for PCa (50.5% vs 29.5%, respectively; p=0.002) and csPCa (43.9% vs 18.1%, respectively; p<0.001). Concerning the biopsy approach, that is, TB in arm A, SB in arm A, and SB in arm B, the overall DRs were significantly different for PCa (60.5% vs 19.2% vs 29.5%, respectively; p<0.001) and for csPCa (56.8% vs 3.8% vs 18.1%, respectively; p<0.001). The reproducibility of the study could have been affected by the single-center nature.

CONCLUSIONS:
A diagnostic pathway based on mpMRI had a higher DR than the standard pathway in both PCa and csPCa.

PATIENT SUMMARY:
In this randomized trial, a pathway for the diagnosis of prostate cancer based on multiparametric magnetic resonance imaging (mpMRI) was compared with the standard pathway based on random biopsy. The mpMRI-based pathway had better performance than the standard pathway.

European Urology. 2016, August 27 [Epub ahead of print] Porpiglia, Francesco et al. European Urology, Volume 72, Issue 2, 282 - 288

Francesco Porpiglia1, Francesco Porpiglia2, Matteo Manfredi2, Fabrizio Mele2, Marco Cossu2, Enrico Bollito3, Andrea Veltri4, Stefano Cirillo5, Daniele Regge6, Riccardo Faletti7, Roberto Passera8, Cristian Fiori2, Stefano De Luca2

1. Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
2. Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
3. Division of Pathology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
4. Division of Radiology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
5. Division of Radiology, Mauriziano Hospital, Turin, Italy
6. Department of Radiology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Turin, Italy
7. Department of Surgical Sciences, Radiology Unit, University of Turin, Città della Salute e della Scienza, Turin, Italy
8. Division of Nuclear Medicine, University of Turin, San Giovanni Battista Hospital, Turin, Italy

PubMed https://www.ncbi.nlm.nih.gov/pubmed/27574821

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