Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?

• Published in: Abdominal imaging 2020-12, Vol.45 (12), p.4160-4165
• Main Authors: Anastay, Vassili, Gondran-Tellier, Bastien, McManus, Robin, Delonca, Raphaelle, Akiki, Akram, Gaillet, Sarah, Delaporte, Veronique, Andre, Marc, Daniel, Laurent, Karsenty, Gilles, Lechevallier, Eric, Boissier, Romain, Baboudjian, Michael
• Format: Article
• Language: English
• Subjects: Antigens; Biopsy; Gastroenterology; Hepatology; Human health and pathology; Imaging; Life Sciences; Magnetic resonance imaging; Medical imaging; Medicine; Medicine & Public Health; Morbidity; Prostate cancer; Prostate-specific antigen; Radiology; Resonance; Scanners; Special Section: Prostate cancer; Ultrasound
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-020-02728-8

Purpose 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). Patients and Methods 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. Results 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/cm 3 and to 100% in patients with PSAd < 0.10 ng/mL/cm 3 . Conclusions 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/cm 3 . Future studies are needed to balance the low benefit of a biopsy in this indication with the morbidity of the procedure.