The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer

To assess the accuracy of multiparametric magnetic resonance imaging (mpMRI) for significant PC detection before diagnostic biopsy in men with abnormal PSA/DRE.

388 men underwent mpMRI including T2-weighted, diffusion-weighted & dynamic contrast-enhanced imaging prior to biopsy.

Two radiologists used PIRADS reporting system to allocate a score of 1-5 for suspicion of significant PC (Gleason 7 with >5% grade 4). PIRADS score 3-5 was considered positive. Transperineal template-guided mapping biopsy of 18-regions (median 30 cores) were performed, with additional manually directed cores from MRI-positive regions. The anatomical location, size, and grade of individual cancer areas in the 18-biopsy regions, as primary outcome, and in prostatectomy specimens (n=117), as secondary outcome, were correlated to the MRI-positive regions.

Of the 388 men that were enrolled, 344 were analyzed. mpMRI was positive in 77. 0% of patients, 62. 5% had PC and 41. 6% had significant PC. Detection of significant PC by mpMRI had sensitivity of 96%, specificity of 36%, NPV and PPV were 92% and 52%. Adding PIRADS to the multivariate model including PSA, DRE, prostate volume and age improved the AUC from 0. 776 to 0. 879, p

In men with abnormal PSA/DRE, mpMRI detected significant PC with an excellent NPV and moderate PPV. The use of mpMRI for diagnosing significant PC may result in a substantial number of unnecessary biopsies while missing minimum number of significant PC.

The Journal of urology. 2015 Oct 31 [Epub ahead of print]

J E Thompson, P J van Leeuwen, D Moses, R Shnier, P Brenner, W Delprado, M Pulbrook, M Böhm, A M Haynes, A Hayen, P D Stricker

St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia. , University of Notre Dame, Darlinghurst, New South Wales, Australia. , Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia. , Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia. , Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia. , School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales, Australia. , St. Vincent's Prostate Cancer Centre, Darlinghurst, New South Wales, Australia; Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia; School of Medicine, University of New South Wales, Kensington, New South Wales, Australia.

PubMed

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