Endorectal multiparametric 3-tesla magnetic resonance imaging associated with systematic cognitive biopsies does not increase prostate cancer detection rate: a randomized prospective trial.
OBJECTIVE
To investigate prostate cancer (PC) detection rate, employing endorectal multiparametric 3-tesla magnetic resonance imaging (MRI) driving subsequent cognitive systematic prostatic biopsy (CSPB) versus a homogenous group of patients who did not undergo endorectal MRI.


METHODS
A series of patients with a first negative biopsy were enrolled in the study. Patients were randomized into two groups: Group A: patients underwent MRI and subsequent CSPB; Group B: patients that did not undergo MRI. Each patient underwent a 13-core sampling. Patients from Group A had four cores more for each MRI suspected lesion. The cancer detection rate was calculated for each group with regard to possible matches or mismatches between MRI evidence and pathological reports.


RESULTS
Two hundred consecutive patients were investigated. Fifty out of 200 (25 %) patients had a diagnosis of PC, 24 in Group A and 26 in Group B. In Group A, 67 patients (67 %) were positive for suspected lesions at the MRI. The mismatch between MRI findings and the CSPB outcome was 61 % with an MRI-driven detection rate of 15 %. Group B detection rate was 26 % with no significant differences versus Group A (P = NS). Patient discomfort was higher in Group A (82 %). The accuracy of CSPB was 41 % with a positive predictive value of 22.3 %. This rate is lower in high-grade cancers (11.9 %). The cost-effectiveness was higher in Group A.


CONCLUSIONS
Prostate cancer detection rate does not improve by CSPB. The accuracy of CSPB was lower in high-grade PC, and a higher cost was found with CSPB.
Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy. gianluigi.taverna@tiscali.it.
Gianluigi
G
Taverna
Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy.
Giorgio
G
Bozzini
Humanitas Research Hospital, Humanitas University, Rozzano, Italy.
Fabio
F
Grizzi
Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy.
Mauro
M
Seveso
Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy.
Alberto
A
Mandressi
Department of Radiology, Humanitas Research Hospital, Rozzano, Italy.
Luca
L
Balzarini
Department of Radiology, Humanitas Research Hospital, Rozzano, Italy.
Federica
F
Mrakic
Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy.
Pietro
P
Bono
Department of Urology, Humanitas Mater Domni, Via Gerenzano 2, 21053, Castellanza, Varese, Italy.
Oliviero
O
De Franceco
Department of Urology, Humanitas Research Hospital, Rozzano, Italy.
NicolòMaria
N
Buffi
Department of Urology, Humanitas Research Hospital, Rozzano, Italy.
Giovanni
G
Lughezzani
Department of Urology, Humanitas Research Hospital, Rozzano, Italy.
Massimo
M
Lazzeri
Department of Urology, Humanitas Research Hospital, Rozzano, Italy.
Paolo
P
Casale
Department of Urology, Humanitas Research Hospital, Rozzano, Italy.
Giorgio Ferruccio
GF
Guazzoni
D000368:Aged; D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012007:Rectum
Detection rate; Magnetic resonance imaging; Prostate biopsy; Prostate cancer