The accuracy of multiparametric MRI in men with negative biopsy and elevated PSA level--can it rule out clinically significant prostate cancer?
OBJECTIVE
To assess the performance of multiparametric magnetic resonance imaging (mp-MRI) in patients with previous negative transrectal ultrasound (TRUS) guided prostate biopsy.


METHODS
Fifty-four patients with at least 1 previous negative TRUS prostate biopsy underwent mp-MRI in the form of T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging. This was followed by transperineal template systematic prostate biopsies. Analysis was done based on 2 sectors per prostate, right and left (108 sectors out of 54 prostates). mp-MRI was scored using an ordinal scale 1 to 5 based on the suspicion of the presence of clinically significant disease. We used 6 different definitions for clinically significant disease and tested the performance of mp-MRI at each single definition.


RESULTS
Median age was 64 (range, 39-75), median PSA level was 10 (range, 2-23), and median number of biopsies was 45 (range, 21-137). Cancer of any volume and any grade was detected in 34 of 54 (63%) patients. mp-MRI accuracy at detection of clinically significant cancer using University College London (UCL) definition 2 (any Gleason score of 4 or maximum cancer core length of ≥ 4 mm or both) showed sensitivity of 76%, specificity of 42%, positive predictive value of 38%, and negative predictive value of 79%. For a different definition of significant tumor (UCL definition 1; dominant Gleason score 4 or maximum cancer core length ≥ 6 mm or both), the sensitivity was 90%, specificity 42%, positive predictive value 26%, and negative predictive value 95%.


CONCLUSIONS
mp-MRI showed good performance at both detection and ruling out clinically significant disease, according to the definition used. mp-MRI can then be used as a triage test in the population with persistently elevated or rising PSA levels to select patients that can avoid unnecessary prostate biopsy.
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Faculty of medicine, Fayoum University, Fayoum, Egypt. Electronic address: mohamed.azeez.10@ucl.ac.uk.
Mohamed
M
Abd-Alazeez
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
Hashim U
HU
Ahmed
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Barts Cancer Institute, Queen Mary, University of London, London, UK.
Manit
M
Arya
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.
Susan C
SC
Charman
Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
Eleni
E
Anastasiadis
Department of Histopathology, University College Hospitals NHS Foundation Trust, London, UK.
Alex
A
Freeman
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
Mark
M
Emberton
Department of Radiology, University College Hospitals NHS Foundation Trust, London, UK.
Alex
A
Kirkham
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D036761:Ultrasound, High-Intensity Focused, Transrectal
D017430:Prostate-Specific Antigen
Clinically significant disease; Multiparametric MRI; Template prostate mapping; negative biopsy