The influence of prostate-specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7-10 prostate cancer in a repeat biopsy setting.

To evaluate the influence of PSA-D on positive (PPV) and negative (NPV) predictive values of mpMRI to detect GS ≥7 cancer in a repeat biopsy setting.

Retrospective study of 514 men with previous prostate biopsy showing no or GS 6 cancer. All had mpMRI, graded 1-5 on a Likert scale for cancer suspicion, and subsequent targeted and 24-core systematic image-fusion guided transperineal biopsy in 2013-2015. NPVs and PPVs of mpMRIs for detecting GS ≥7 cancer were calculated (±95% confidence intervals) for PSA-D ≤0.1, 0.1-0.2, ≤0.2 and >0.2 ng/ml/cm(3) , and compared by Chi-square test for linear trend.

GS ≥7 cancer was detected in 31% of the men. NPV of Likert 1-2 mpMRI was 0.91 (±0.04) with PSA-D ≤0.2 and 0.71 (±0.16) with >0.2 (p=0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with PSA-D ≤0.2 and 0.44 (±0.19) with >0.2 (p=0.002). PSA-D also significantly affected the PPV of Likert 4-5 mpMRI lesions: the PPV was 0.47 (±0.08) with PSA-D ≤0.2 and 0.66 (±0.10) with >0.2 (p=0.0001).

In a repeat biopsy setting, PSA-D ≤0.2 is associated with low detection of GS ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with high PSA-D, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if PSA-D is low. This article is protected by copyright. All rights reserved.

BJU international. 2016 Aug 04 [Epub ahead of print]

N L Hansen, T Barrett, B Koo, A Doble, V Gnanapragasam, A Warren, C Kastner, O Bratt

Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany., CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK., CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.