Can multiparametric magnetic resonance of the prostate avoid biopsies in patients with elevated PSA and surgical indicat
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Can multiparametric magnetic resonance of the prostate avoid biopsies in patients with elevated PSA and surgical indication for benign prostatic enlargement? Marcelo Langer Wroclawski1 · Paulo Priante Kayano1 · Breno Santos Amaral1 · Guilherme Cayres Mariotti1 · Fernando Ide Yamauchi1 · Jonathan Doyun Cha1 · Arie Carneiro1 · Fernando Korkes1 · Alessandra Sousa Vitalli1 · Thais Caldara Mussi1 · Gustavo Caserta Lemos1 · Ronaldo Hueb Baroni1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction To evaluate the clinical dilemma of men with surgical indication due to benign prostatic enlargement (BPE) and concomitant elevated PSA, we analysed if multiparametric magnetic resonance imaging (mpMRI) could safely prescind the prostate biopsy. Methods Forty men with surgical indication due to BPE and concomitantly elevated PSA levels were prospectively enrolled and retrospectively analysed. All patients underwent 1.5 Tesla mpMRI prior to TRUS-guided biopsies. In cases where mpMRI was PIRADS 3 with focal lesions, PIRADS 4 or PIRADS 5, additional fragments were obtained with the fusion guided technique. Biopsy histopathological results were used as the standard of reference. Two scenarios were evaluated: scenario 1, considering mpMRI PIRADS 1 and 2 as negative; and scenario 2, considering PIRADS 1, 2 and 3 as negative. Clinically significant prostate cancer (CsPCa) was defined as ISUP ≥ 2. Results Median age was 68 years, median PSA was 9.41 (6.40–19.54) and median prostatic volume was 116.5 cc (IQR 86.5–155). Scenario 1 mpMRI sensitivity, specificity, PPV, NPV and accuracy for any prostate cancer on prostate biopsy was 76.9%, 63%, 50%, 85% and 67.5%. For csPCa, they were 87.5%, 59.4%, 35%, 95% and 65%, respectively, for the same measures. Scenario 2 the sensitivity, specificity, PPV, NPV and accuracy of mpMRI for any prostate cancer on prostate biopsy was 53.8%, 96.3%, 87.5%, 81.3% and 82.5%. For csPCa, they were 75%, 93.8%, 75%, 93.8% and 90%, respectively, for the same measures. Conclusion Prostate mpMRI may prevent unnecessary biopsies in patients with elevated PSA and surgical indications due to BPE, given its high negative predictive value. Keywords Prostate · Prostatic neoplasms · Prostatic hyperplasia · Magnetic resonance imaging · Biopsy · Prostate-specific antigen
Introduction Benign prostatic enlargement (BPE) is the most common benign neoplasm in men, affecting more than 50% of men over 60 years of age [1]. Almost 30% of patients with lower urinary tract symptoms (LUTS) due to BPE need treatment * Marcelo Langer Wroclawski [email protected] 1
Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP CEP: 01451‑010, Brazil
and approximately 20% are refractory to clinical treatment or present with complications [2] and, therefore, undergo surgery. Patients with BPE may have increased prostate specific antigen (PSA) levels [3], posing a clinical dilemma as to whether or not to perform transrectal ultrasound (TRUS) biopsy to rule ou
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