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Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?

  • Special Section: Prostate cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

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/cm3 and to 100% in patients with PSAd < 0.10 ng/mL/cm3.

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/cm3. Future studies are needed to balance the low benefit of a biopsy in this indication with the morbidity of the procedure.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France

    Vassili Anastay, Bastien Gondran-Tellier, Robin McManus, Raphaelle Delonca, Akram Akiki, Sarah Gaillet, Veronique Delaporte, Gilles Karsenty, Eric Lechevallier, Romain Boissier & Michael Baboudjian

  2. Department of Radiology and Medical Imaging, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France

    Marc Andre

  3. Department of Pathological Anatomy and Cytology, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France

    Laurent Daniel

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  1. Vassili Anastay
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  2. Bastien Gondran-Tellier
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Correspondence to Michael Baboudjian.

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Anastay, V., Gondran-Tellier, B., McManus, R. et al. Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?. Abdom Radiol 45, 4160–4165 (2020). https://doi.org/10.1007/s00261-020-02728-8

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  • DOI: https://doi.org/10.1007/s00261-020-02728-8

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