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Multiparametric MRI cuts rate of unnecessary repeat prostate biopsies

04 Oct 2018

Use of multiparametric magnetic resonance imaging (MRI) significantly lowers the number of unnecessary repeat prostate biopsies in about 50 percent of cases in which a Prostate Imaging Reporting and Data System (PI-RADS) score of ≥3 is used, a recent study has shown.

“At the same time patients should be informed of the 16.2 percent and 39.7 percent false-negative rates of clinically significant prostate cancer for targeted fusion prostate biopsy of PI-RADS 3 and 4 lesions, respectively,” the authors said.

Of the 1,032 patients, 372 (36 percent) had T1c prostate cancer, and 272 (73.1 percent) of such cases were classified as clinically significant prostate cancer.

The respective diagnosis of clinically significant prostate cancers following saturation prostate biopsy vs targeted fusion prostate biopsy and a PI-RADS score of ≥3 vs targeted fusion prostate biopsy and a PI-RADS score of ≥4 was 95.6 percent vs 83.8 percent vs 60.3 percent (p<0.0001).

Of the 272 clinically significant prostate cancers, 12 (4.5 percent) were missed by saturation prostate biopsy vs 44 (16.2 percent) and 108 (39.7 percent) by targeted fusion prostate biopsy and a PI-RADDS score of ≥3 or a score of ≥4, respectively (p<0.0001).

Multiparametric MRI as a triage test would have spared 49.3 percent of patients compared with 73.6 percent of those using a PI-RADS cutoff of ≥3 or ≥4.

In this study, repeat saturation prostate biopsy (the reference test) was performed from January 2011 to February 2018 due to suspicion of cancer in 1,032 men with a median age of 63 years in whom median prostate-specific antigen was 8.6 ng/ml. Prior to saturation prostate biopsy, all patients underwent 3.0 Tesla pelvic multiparametric MRI. Additional targeted fusion prostate biopsy was done of lesions with a PI-RADS score of ≥3.

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