Endorectal multiparametric 3-tesla magnetic resonance imaging associated with systematic cognitive biopsies does not increase prostate cancer detection rate: a randomized prospective trial

To investigate prostate cancer (PC) detection rate, employing endorectal multiparametric 3-tesla magnetic resonance imaging (MRI) driving subsequent cognitive systematic prostatic biopsy (CSPB) versus a homogenous group of patients who did not undergo endorectal MRI.

A series of patients with a first negative biopsy were enrolled in the study. Patients were randomized into two groups: Group A: patients underwent MRI and subsequent CSPB; Group B: patients that did not undergo MRI. Each patient underwent a 13-core sampling. Patients from Group A had four cores more for each MRI suspected lesion. The cancer detection rate was calculated for each group with regard to possible matches or mismatches between MRI evidence and pathological reports.

Two hundred consecutive patients were investigated. Fifty out of 200 (25 %) patients had a diagnosis of PC, 24 in Group A and 26 in Group B. In Group A, 67 patients (67 %) were positive for suspected lesions at the MRI. The mismatch between MRI findings and the CSPB outcome was 61 % with an MRI-driven detection rate of 15 %. Group B detection rate was 26 % with no significant differences versus Group A (P = NS). Patient discomfort was higher in Group A (82 %). The accuracy of CSPB was 41 % with a positive predictive value of 22. 3 %. This rate is lower in high-grade cancers (11. 9 %). The cost-effectiveness was higher in Group A.

Prostate cancer detection rate does not improve by CSPB. The accuracy of CSPB was lower in high-grade PC, and a higher cost was found with CSPB.

World journal of urology. 2015 Oct 19 [Epub ahead of print]

Gianluigi Taverna, Giorgio Bozzini, Fabio Grizzi, Mauro Seveso, Alberto Mandressi, Luca Balzarini, Federica Mrakic, Pietro Bono, Oliviero De Franceco, NicolòMaria Buffi, Giovanni Lughezzani, Massimo Lazzeri, Paolo Casale, Giorgio Ferruccio Guazzoni

Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy. Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy. , Humanitas Research Hospital, Humanitas University, Rozzano, Italy. , Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy. , Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy. , Department of Radiology, Humanitas Research Hospital, Rozzano, Italy. , Department of Radiology, Humanitas Research Hospital, Rozzano, Italy. , Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy. , Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy. , Department of Urology, Humanitas Research Hospital, Rozzano, Italy. , Department of Urology, Humanitas Research Hospital, Rozzano, Italy. , Department of Urology, Humanitas Research Hospital, Rozzano, Italy. , Department of Urology, Humanitas Research Hospital, Rozzano, Italy. , Department of Urology, Humanitas Research Hospital, Rozzano, Italy.

PubMed

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