PURPOSE: We aimed to determine the performance of multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa) in patients with prior negative transrectal ultrasound-guided prostate biopsy (TRUS-B) results.
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MATERIALS AND METHODS: Between 2010 and 2013, 2,416 men underwent TRUS-B or an mpMRI or both at Vancouver General Hospital. Among these, 283 men had persistent suspicion of PCa despite prior negative TRUS-B finding. An MRI was obtained in 112, and a lesion (prostate imaging reporting and data system score ≥3) was identified in 88 cases (78%). A subsequent combined MRI-targeted and standard template biopsy was performed in 86 cases. A matching cohort of 86 patients was selected using a one-nearest neighbor method without replacement. The end points were the rate of diagnosis of PCa and significant PCa (sPCa) (Gleason>6, or>2 cores, or>50% of any core).
RESULTS: MRI-targeted TRUS-B detected PCa and sPCa in 36 (41.9%) and 30 (34.9%) men when compared with 19 (22.1%) and 14 (16.3%), respectively, men without mpMRI (P = 0.005 for both). In 9 cases (10.4%), MRI-targeted TRUS-B detected sPCa that was missed on standard cores. sPCa was present in 6 cases (6.9%) on standard cores but not the targeted cores. Multivariate analysis revealed that prostate imaging reporting and data system score and prostate-specific antigen density>0.15ng/ml2 were statistically significant predictors of significant cancer detection (odds ratio = 14.93, P< 0.001 and odds ratio = 6.19, P = 0.02, respectively).
CONCLUSION: In patients with prior negative TRUS-B finding, MRI-targeted TRUS-B improves the detection rate of all PCa and sPCa.
Abdi H, Zargar H, Goldenberg SL, Walshe T, Pourmalek F, Eddy C, Chang SD, Gleave ME, Harris AC, So AI, Machan L, Black PC. Are you the author?
Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Department of Radiology, University of British Columbia, Vancouver, Canada.
Reference: Urol Oncol. 2015 Feb 6. pii: S1078-1439(15)00006-X.