title: The influence of prostate-specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7-10 prostate cancer in a repeat biopsy setting.
abstract: To evaluate the influence of prostate-specific antigen density (PSAD) on positive (PPV) and negative (NPV) predictive values of multiparametric magnetic resonance imaging (mpMRI) to detect Gleason score ≥7 cancer in a repeat biopsy setting.
  
  
  
  Retrospective study of 514 men with previous prostate biopsy showing no or Gleason score 6 cancer. All had mpMRI, graded 1-5 on a Likert scale for cancer suspicion, and subsequent targeted and 24-core systematic image-fusion guided transperineal biopsy in 2013-2015. The NPVs and PPVs of mpMRIs for detecting Gleason score ≥7 cancer were calculated (±95% confidence intervals) for PSAD ≤0.1, 0.1-0.2, ≤0.2 and >0.2 ng/mL/mL, and compared by chi-square test for linear trend.
  
  
  
  Gleason score ≥7 cancer was detected in 31% of the men. The NPV of Likert 1-2 mpMRI was 0.91 (±0.04) with a PSAD of ≤0.2 ng/mL/mL and 0.71 (±0.16) with a PSAD of >0.2 ng/mL/mL (P = 0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with a PSAD of ≤0.2 ng/mL/mL and 0.44 (±0.19) with a PSAD of >0.2 ng/mL/mL (P = 0.002). PSAD also significantly affected the PPV of Likert 4-5 mpMRI lesions: the PPV was 0.47 (±0.08) with a PSAD of ≤0.2 ng/mL/mL and 0.66 (±0.10) with a PSAD of >0.2 ng/mL/mL (P < 0.001).
  
  
  
  In a repeat biopsy setting, a PSAD of ≤0.2 ng/mL/mL is associated with low detection of Gleason score ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with a high PSAD, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if the PSAD is low.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.|CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Nienke L
authors.initials: NL
authors.lastname: Hansen
authors.affiliation: CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.|Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Tristan
authors.initials: T
authors.lastname: Barrett
authors.affiliation: CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.|Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Brendan
authors.initials: B
authors.lastname: Koo
authors.affiliation: CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.|Department of Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Doble
authors.affiliation: CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.|Academic Urology Group, Department of Surgery and Oncology, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gnanapragasam
authors.affiliation: CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.|Department of Pathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Warren
authors.affiliation: CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.|Department of Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Christof
authors.initials: C
authors.lastname: Kastner
authors.affiliation: CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.|Department of Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Ola
authors.initials: O
authors.lastname: Bratt
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D006801:Humans; D061705:Image-Guided Biopsy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen
keywords: image fusion; magnetic resonance imaging; prostate biopsy; prostate cancer; prostate-specific antigen density; transperineal biopsy