Negative Multiparametric Magnetic Resonance Imaging of the Prostate Predicts Absence of Clinically Significant Prostate Cancer on 12-Core Template Prostate Biopsy.
To determine the negative predictive value of multiparametric magnetic resonance imaging (mpMRI), we evaluated the frequency of prostate cancer detection by 12-core template mapping biopsy in men whose mpMRI showed no suspicious regions.



Six hundred seventy patients underwent mpMRI followed by transrectal ultrasound (TRUS)-guided systematic prostate biopsy from December 2012 to June 2016. Of this cohort, 100 patients had a negative mpMRI. mpMRI imaging sequences included T2-weighted and diffusion-weighted imaging, and dynamic contrast enhancement sequences.



The mean age, prostate-specific antigen, and prostate volume of the 100 men included were 64.3 years, 7.2 ng/mL, and 71 mL, respectively. Overall cancer detection was 27% (27 of 100). Prostate cancer was detected in 26.3% (10 of 38) of patients who were biopsy-naïve, 12.1% (4 of 33) of patients who had a prior negative biopsy, and in 44.8% (13 of 29) of patients previously on active surveillance; Gleason grade ≥7 was detected in 3% of patients overall (3 of 100). The negative predictive value of a negative mpMRI was 73% for all prostate cancer and 97% for Gleason ≥7 prostate cancer.



There is an approximately 3% chance of detecting clinically significant prostate cancer with systematic TRUS-guided biopsy in patients with no suspicious findings on mpMRI. This information should help guide recommendations to patients about undergoing systematic TRUS-guided biopsy when mpMRI is negative.
Department of Urology, Yale School of Medicine, New Haven, CT.
Amanda J
AJ
Lu
Department of Urology, Yale School of Medicine, New Haven, CT.
Jamil S
JS
Syed
Department of Urology, Yale School of Medicine, New Haven, CT.
Kevin A
KA
Nguyen
Department of Urology, Yale School of Medicine, New Haven, CT.
Cayce B
CB
Nawaf
Department of Urology, Yale School of Medicine, New Haven, CT.
James
J
Rosoff
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT.
Michael
M
Spektor
Department of Pathology, Yale School of Medicine, New Haven, CT.
Angelique
A
Levi
Department of Pathology, Yale School of Medicine, New Haven, CT.
Peter A
PA
Humphrey
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT.
Jeffrey C
JC
Weinreb
Department of Urology, Yale School of Medicine, New Haven, CT.
Peter G
PG
Schulam
Department of Urology, Yale School of Medicine, New Haven, CT. Electronic address: Preston.Sprenkle@yale.edu.
Preston C
PC
Sprenkle
D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D061705:Image-Guided Biopsy; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D018084:Ultrasonography, Interventional
D003287:Contrast Media; D017430:Prostate-Specific Antigen