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Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?

Abstract : Purpose To evaluate the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI), alone or combined with Prostate-Specific Antigen density (PSAd) to exclude clinically significant prostate cancer (csPCa). Patients and Methods We performed a retrospective chart review of all the patients who had transrectal ultrasound-guided biopsy (TRUSGB) in our center between January 2014 and March 2019. We included patients who had nonsuspicious prebiopsy mpMRI defined as Prostate Imaging-Reporting and Data System (PI-RADS) <= 2. MRI was performed using a 1.5 or 3-Tesla Magnetic Resonance scanners with external phased-array coil. The primary outcome was the detection of csPCa, defined as a Gleason score 3 + 4 (ISUP 2) or higher on at least one biopsy core. Results One hundred and ninety-one consecutive men (median age: 65 years, median PSA level: 9.3 ng/mL) underwent TRUSGB following negative prebiopsy mpMRI corresponding to 126 (66%) biopsy-naive patients, 36 (18.8%) patients with prior negative biopsy, and 29 (15.2%) patients under active surveillance with confirmatory biopsies. The overall PCa and csPCA detection rates were 26.7% and 5.2%, conferring a NPV of 73.3% and 94.8%, respectively. The NPV of negative mpMRI improved to 95.8% in patients with PSAd < 0.15 ng/mL/cm(3)and to 100% in patients with PSAd < 0.10 ng/mL/cm(3). Conclusions A negative prebiopsy mpMRI had an overall NPV of 94.8% for csPCa when mpMRI was used alone to 95.8% when combined with PSAd < 0.15 ng/mL/cm(3). Future studies are needed to balance the low benefit of a biopsy in this indication with the morbidity of the procedure.
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https://hal-amu.archives-ouvertes.fr/hal-03208692
Contributor : Annick Prémilleux <>
Submitted on : Monday, April 26, 2021 - 5:34:28 PM
Last modification on : Tuesday, April 27, 2021 - 11:44:51 AM

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Vassili Anastay, Bastien Gondran-Tellier, Robin Mcmanus, Raphaelle Delonca, Akram Akiki, et al.. Nonsuspicious prebiopsy multiparametric MRI: is prostate biopsy still necessary?. Abdominal Radiology, Springer, 2020, 45 (12), pp.4160-4165. ⟨10.1007/s00261-020-02728-8⟩. ⟨hal-03208692⟩

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