title: What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging?
abstract: OBJECTIVE
  To analyse the characteristics of prostate cancers (PrCa) detected following negative multiparametric magnetic resonance imaging (mpMRI).
  
  
  METHODS
  Eight hundred and thirty patients with elevated prostate-specific antigen (mean 11.9 μg/l) underwent mpMRI of the prostate at 1.5 Tesla with endorectal coil. The characteristics of all PrCa detected within 2 years after a negative mpMRI were analysed. Primary Gleason grade 4 or any grade 5 PrCa were considered high-grade (HG), Gleason score 3 + 4 intermediate grade (IG) and Gleason score ≤3 + 3 low-grade (LG). Tumour size was considered 'small' when <1 cm on radical prostatectomy specimen or limited to ≤2 cores on prostate biopsy.
  
  
  RESULTS
  mpMRI was negative in 391 patients (47.1 %). In 124 patients (31.7 %) PrCa was detected within 2 years. Eighty-four (67.7 %) were LG, 22 (17.7 %) IG and 18 (14.5 %) HG. 119 (96.0 %) of the missed PrCa were organ-confined. The negative predictive value was 95.4 % (373/391) for HG PrCa. Among the 18 missed HG PrCa, 15 (83.3 %) were organ-confined and 12 (66.6 %) were small.
  
  
  CONCLUSIONS
  The majority of missed tumours on mpMRI were low grade and organ-confined. In patients with elevated PSA and a negative mpMRI, consideration could be given to continued surveillance rather than immediate biopsy.
  
  
  CONCLUSIONS
  • The majority of missed prostate cancers were low grade and organ-confined. • In patients with a negative mpMRI a biopsy may be postponed. • mpMRI had a negative predictive value of 95.4 % for high-grade prostate cancer.
authors.affiliation: Department of Radiology, Ghent University Hospital, 0 DPP, De Pintelaan 185, 9000, Gent, Belgium. pieter.devisschere@uzgent.be.
authors.forename: Pieter Julien Luc
authors.initials: PJ
authors.lastname: De Visschere
authors.affiliation: Department of Radiology, Ghent University Hospital, 0 DPP, De Pintelaan 185, 9000, Gent, Belgium.
authors.forename: Leslie
authors.initials: L
authors.lastname: Naesens
authors.affiliation: Department of Pathology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
authors.forename: Louis
authors.initials: L
authors.lastname: Libbrecht
authors.affiliation: Department of Urology, Ghent University Hospital, 0P3, De Pintelaan 185, 9000, Gent, Belgium.
authors.forename: Charles
authors.initials: C
authors.lastname: Van Praet
authors.affiliation: Department of Urology, Ghent University Hospital, 0P3, De Pintelaan 185, 9000, Gent, Belgium.
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Lumen
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, 0P8, De Pintelaan 185, 9000, Gent, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Fonteyne
authors.affiliation: Department of Radiology, Ghent University Hospital, 0 DPP, De Pintelaan 185, 9000, Gent, Belgium.
authors.forename: Eva
authors.initials: E
authors.lastname: Pattyn
authors.affiliation: Department of Radiology, Ghent University Hospital, 0 DPP, De Pintelaan 185, 9000, Gent, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Villeirs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results
chemical_list: D017430:Prostate-Specific Antigen
keywords: Diffusion magnetic resonance imaging; Magnetic resonance imaging; Magnetic resonance spectroscopy; Prostate; Prostatic neoplasms