Presentation Authors: Spencer Hart, Chirag Doshi, Thomson Tai*, Ryan Dornbier, Maywood, IL, Cara Joyce, Chicago, IL, Alex Gorbonos, Michael Woods, Marcus Quek, Robert Flanigan, Gopal Gupta, Maywood, IL
Introduction: The diagnostic management of men presenting for evaluation for prostate cancer can be challenging, particularly in those who are found to have a negative 12-core biopsy. Multi-parametric MRI (mpMRI) affords important information regarding suspicious lesions within the prostate that were previously unrecognized in the pre-MRI era. The aim of this study was to describe the negative predictive value of mpMRI in the detection of clinically significant prostate cancer for men undergoing evaluation for suspected prostate cancer.
Methods: A retrospective analysis was performed on men who underwent mpMRI of the prostate with targeted biopsy and standard 12 core biopsy between January 2015 through July of 2018. PI-RADs version 2 was utilized to identify lesions suggestive of underlying prostate cancer. All lesions with PI-RADs score greater than 3 were biopsied in a targeted fashion. Gleason scores from standard 12 core biopsies and targeted biopsies were included for analysis. For the purposes of this study, we defined clinically significant prostate cancer as Gleason score 7 or greater. Standard 12-core biopsy was considered the â€œgold standardâ€ for comparative assessment. The negative predictive value of mpMRI with targeted biopsy was assessed.
Results: A total of 592 men underwent mpMRI with targeted biopsy and concurrent standard 12 core biopsy. When compared to standard 12 core biopsy, mpMRI was found to have superior negative predictive value (92.3%; 95% CI: (89.8%-94.8%)) for men undergoing evaluation for prostate cancer. mpMRI with targeted biopsy was also more likely to detect clinically significant prostate cancer when compared to standard 12 core biopsy (27.5% vs 22.3%; p=0.002).
Conclusions: The negative predictive value of mpMRI provides useful insight in the assessment of men undergoing work up for prostate cancer. Utilization of the negative predictive value of mpMRI for clinically significant prostate cancer may reduce the unwanted detection of low risk prostate cancers.