title: Multiparametric magnetic resonance imaging predicts the presence of prostate cancer in patients with negative prostate biopsy.
abstract: OBJECTIVE
  To assess the ability of multiparametric prostate magnetic resonance imaging (mpMRI) to detect prostate cancer in patients with prior negative transrectal prostate biopsy (TPB).
  
  
  METHODS
  mpMRI (TSE-T2-w, DWI and DCE sequences) was performed on 1.5T (Magnetom Avanto; Siemens Healthcare Solutions) in 150 patients suspicious of prostate cancer and with negative TPB. European Society of Urogenital Radiology (ESUR) criteria were used (score 1: clinically significant disease is highly unlikely to be present; score 2: clinically significant cancer is unlikely to be present; score 3: clinically significant cancer is equivocal; score 4: clinically significant cancer is likely to be present; score 5: clinically significant cancer is highly likely to be present). PSA measurement (total and free), digital rectal examination (DRE), transrectal ultrasound (TRU) and a second TPB (at least 14 cylinders) were performed in all patients. Variables were submitted for independent blind analysis. The accuracy of each test was measured. Stepwise selection model for prediction of prostate cancer in second TPB was developed.
  
  
  RESULTS
  Mean age was 66.2± 5 years (51-77), mean PSA 11.3± 9.6ng/mL (0.9-75) and mean prostatic volume 82.2±42 (20-250) cc. DRE was suspicious in 11 (7.3%) patients. The mean number of cylinders per patient sampled in second TRB was 17.6±2.7(14-22). Second TRB was positive in 28 patients (18.7%). mpMRI was positive (score 3-5) in 102 (68%), test sensibility was 92.9% and the NPV was 95.8%. The risk of prostate cancer diagnosis in second TPB is modified by: PSA velocity > 0.75 (OR 1.04 [0.99-1.08]; P=0.06), free/total ratio PSA <15% (OR 0.37 [0.13-1.05]; P=0.06), each cc. of prostate volume (OR 0.98 [0.97-1]; P=0.017) and mpMRI 3-5 (OR 7.87 [1.78-34.7]; P=0.006). Multivariate analysis reveals that mpMRI (OR 7.41 [1.65-33.28]; P=0.009) and prostatic volume (OR 0.31 [0.12-0.78]; P=0.01) are independent risk predictors of prostate cancer.
  
  
  CONCLUSIONS
  According to ESUR guidelines and in patients with prior negative prostate biopsy, mpMRI is a valuable tool for the prediction of prostate cancer in second TPB. Lower prostate volume, the higher reliability.
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, España. Electronic address: fernandolista@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Lista
authors.affiliation: Servicio de Radiodiagnóstico, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Castillo
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, España.
authors.forename: H
authors.initials: H
authors.lastname: Gimbernat
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Rodríguez-Barbero
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitario de Getafe, Getafe, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Panizo
authors.affiliation: Servicio de Urología, Hospital Universitario de Getafe, Getafe; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Angulo
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D000368:Aged; D019540:Area Under Curve; D001706:Biopsy / Q000379:methods; D005188:False Negative Reactions; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
chemical_list: D017430:Prostate-Specific Antigen
keywords: Cáncer de próstata; Estudio multiparamétrico; Imagen por resonancia magnética; Magnetic resonance imaging; Multiparametric study; Prostate; Prostate cancer; Próstata; Second biopsy; Segunda biopsia