Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?
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SPECIAL SECTION: PROSTATE CANCER
Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary? Vassili Anastay1 · Bastien Gondran‑Tellier1 · Robin McManus1 · Raphaelle Delonca1 · Akram Akiki1 · Sarah Gaillet1 · Veronique Delaporte1 · Marc Andre2 · Laurent Daniel3 · Gilles Karsenty1 · Eric Lechevallier1 · Romain Boissier1 · Michael Baboudjian1 Received: 28 June 2020 / Revised: 17 August 2020 / Accepted: 30 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Prostate cancer · MRI · Biopsy · Prostate-specific antigen
Introduction Correlation with radical prostatectomy specimens shows that multiparametric magnetic resonance imaging (mpMRI) has good sensitivity for the detection and localization of * Michael Baboudjian Michael.BABOUDJIAN@ap‑hm.fr 1
Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
2
Department of Radiology and Medical Imaging, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
3
Department of Pathological Anatomy and Cytology, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
International Society of Urological Pathology (ISUP) grade ≥ 2 prostate cancers (PCa) [1, 2]. As shown in recently published randomized controlled trials, head-to-head comparisons, and a Cochrane meta-an
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