Can multi-parametric prostate MRI eliminate unnecessary biopsies and the diagnosis of insignificant prostate cancer? Data analysis of over 650 prostate mpMRI

摘要

Introduction & objectives: Diagnosis of indolent prostate cancer – PCa has a negative clinical and psychological impact on men, with questionable improved survival. In this prospective study we evaluated the ability of mpMRI to predict the absence of clinically significant PCa, as a diagnostic tool. Methods: All patients with elevated PSA or abnormal digital rectal examination, family history of aggressive PCa, or on active surveillance protocol where offered mpMRI of the prostate. The mpMRI was reviewed by two independent senior prostate MR radiologists, and any lesion classified according to PI-RADS classification. The relationship between the diagnostic ability of mpMRI sequences to predict absence of disease and the biopsy pathology results were evaluated by the specificity and negative (NPV) predictive value based on T2-weighted imaging (T2), apparent diffusion coefficient (ADC) map, and dynamic contrast imaging (DCI). Results: A total of 657 consecutive patients with prostate mpMRI were included in this ongoing prospective study, median age 63 (42–74) years old, median PSA 5.4 ng/mL (1.7–33). PIRADS 1 and 2 on the mpMRI were found in 390 patients, median age 63 and PSA 4.8 ng/mL. 187 patients had previous biopsy available, and 139 of them did not require an additional investigation after the mpMRI was performed. Post MRI repeat biopsy was done in 48 patients. In 6 patients Gleason's 7 was found, 2 had prostatectomy with low volume minimal disease on final histology. The other five patients required no treatment, along with additional 35 patients with BPH in their repeat biopsy. 203 had primary MRI with no previous biopsy, 96 required no further investigation and 107 patients had biopsy follow the MRI. No cancer was found in 77 patients. Gleason's 6, found in 20 patients, one had prostatectomy, with low volume disease on final histology. Six out of 9 patients with Gleason's 7 had prostatectomy, of them only two with significant disease on final histology. Additional Gleason's (4 + 4) was treated with prostatectomy. A total of 3 clinically significant disease was detected in our study group of 390 patients with PIRADS 1 and 2 on mpMRI. Conclusion: Our results demonstrate an outstanding accuracy of mpMRI, to predict a healthy prostate. We strongly believe that mpMRI done by experienced radiologists is a useful screening tool preventing unnecessary prostate biopsies and reducing over diagnosis of insignificant disease.