https://doi.org/10.4081/aiua.2022.1.32

Do all patients with suspicious prostate cancer need Multiparametric Magnetic Resonance Imaging before prostate biopsy?

Vol. 94 No. 1 (2022)
Submitted: November 17, 2021
Accepted: December 23, 2021
Published: March 28, 2022
Prostate cancer, PSA, PSA density, digital rectal examination, mpMRI, PI-RADS
Abstract Views: 651
PDF: 396
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Authors

Sara Teixeira Anacleto
sara.anacleto241@gmail.com
Department of Urology - Hospital of Braga; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Joana Neves Alberto
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Emanuel Carvalho Dias
Department of Urology - Hospital of Braga; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Pedro Sousa Passos
Department of Urology - Hospital da Senhora da Oliveira, Guimarães, Portugal.
Mário Cerqueira Alves
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.

Objectives: Multiparametric magnetic resonance imaging (mpMRI) is a useful tool to diagnose prostate cancer (PCa) but its cost is not negligible. In order to reduce costs and minimize time to diagnosis, it is necessary to establish which patients benefit the most from doing mpMRI prior to prostate biopsy (PB). Our aim was to test if mpMRI still predicts PCa and clinically significant PCa (csPCa) in patients with high clinical suspicion of cancer, defined as prostate specific antigen (PSA) > 10 ng/ml, PSA-Density (PSAD) > 0.15 ng/ml/cc or suspicious digital rectal examination (DRE).
Materials and methods: We retrospectively collected data on 206 patients who underwent mpMRI before PB at our Department from January 2017 to July 2018. mpMRI results were classified using Prostate Imaging Reporting and Data System (PI-RADS) version 2. In primary analysis, we evaluated the association of mpMRI with PCa and csPCa and stratified this model for low and high clinical suspicion of cancer. In secondary analysis, we determined the rate of negative PB results in patients with high suspicion of cancer and compared theses rates with those obtained if only those with PI-RADS 3-5 would be biopsied.
Results: In primary analysis and overall, mpMRI was predictive of PCa and csPCa. In stratified analysis, mpMRI was still significantly associated with csPCa in patients with PSA > 10 ng/ml and PSAD > 0.15 ng/ml/cc, but not in those with suspicious DRE. In secondary analysis, negative result rates were lower if only patients with PI-RADS 3-5 were biopsied, even in subgroups with high suspicion of cancer based on PSA and PSAD. In patients with suspicious DRE, however, the rate of negative results did not change significantly if only patients with PI-RADS 3-5 were biopsied.
Conclusions: mpMRI is still useful in predicting csPCa in patients with PSA > 10 ng/mL and PSAD > 0.15 ng/ml/cc. If DRE is suspicious, though, mpMRI might be no longer useful in the prediction of PCa.

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How to Cite

Teixeira Anacleto, S., Neves Alberto, J., Carvalho Dias, E., Sousa Passos, P., & Cerqueira Alves, M. . (2022). Do all patients with suspicious prostate cancer need Multiparametric Magnetic Resonance Imaging before prostate biopsy?. Archivio Italiano Di Urologia E Andrologia, 94(1), 32–36. https://doi.org/10.4081/aiua.2022.1.32

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