To evaluate the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI), alone or combined with Prostate-Specific Antigen density (PSAd) to exclude clinically significant prostate cancer (csPCa).
We performed a retrospective chart review of all the patients who had transrectal ultrasound-guided biopsy (TRUSGB) in our center between January 2014 and March 2019. We included patients who had nonsuspicious prebiopsy mpMRI defined as Prostate Imaging-Reporting and Data System (PI-RADS) ≤ 2. MRI was performed using a 1.5 or 3-Tesla Magnetic Resonance scanners with external phased-array coil. The primary outcome was the detection of csPCa, defined as a Gleason score 3 + 4 (ISUP 2) or higher on at least one biopsy core.
One hundred and ninety-one consecutive men (median age: 65 years, median PSA level: 9.3 ng/mL) underwent TRUSGB following negative prebiopsy mpMRI corresponding to 126 (66%) biopsy-naïve patients, 36 (18.8%) patients with prior negative biopsy, and 29 (15.2%) patients under active surveillance with confirmatory biopsies. The overall PCa and csPCA detection rates were 26.7% and 5.2%, conferring a NPV of 73.3% and 94.8%, respectively. The NPV of negative mpMRI improved to 95.8% in patients with PSAd < 0.15 ng/mL/cm3 and to 100% in patients with PSAd < 0.10 ng/mL/cm3.
A negative prebiopsy mpMRI had an overall NPV of 94.8% for csPCa when mpMRI was used alone to 95.8% when combined with PSAd < 0.15 ng/mL/cm3. Future studies are needed to balance the low benefit of a biopsy in this indication with the morbidity of the procedure.
Abdominal radiology (New York). 2020 Sep 09 [Epub ahead of print]
Vassili Anastay, Bastien Gondran-Tellier, Robin McManus, Raphaelle Delonca, Akram Akiki, Sarah Gaillet, Veronique Delaporte, Marc Andre, Laurent Daniel, Gilles Karsenty, Eric Lechevallier, Romain Boissier, Michael Baboudjian
Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France., Department of Radiology and Medical Imaging, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France., Department of Pathological Anatomy and Cytology, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France., Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France. .