Presentation Authors: Grant M Henning*, Joel M Vetter, Gerald L Andriole, Michael S Chevinsky, Eric H Kim, St. Louis, MO
Introduction: African-American men (AA) have a higher incidence of prostate cancer (PCa) and tend to have more advanced disease at presentation than white-American men (W). Little data currently exists demonstrating the effectiveness of prostate multiparametric magnetic resonance imaging (mpMRI) in this high-risk group, despite widespread adoption of mpMRI as a diagnostic tool for PCa. We aim to compare the accuracy of prostate mpMRI in AA and W men.
Methods: We examined our prostate mpMRI database from October 2014 to June 2017 and identified 601 men who underwent 3-Tesla prostate mpMRI prior to biopsy (58 AA, 541 W). All prostate mpMRI were reported using the Prostate Imaging Reporting and Data System (PIRADS). All men received a systematic standard template prostate biopsy, and men with PIRADS classification 3 to 5 lesions underwent additional MRI targeted biopsy using the UroNav platform. For our analysis, we examined diagnostic accuracy of prostate mpMRI for detecting clinically significant PCa, treating PIRADS classification 4 or 5 as test positive and Gleason grade group (GGG) 2 or higher as clinically significant PCa. Propensity score matching was used to match 58 AA to 115 W in a 1:2 ratio by age, PSA, and PSA density.
Results: In our matched comparison, average age (62.6 vs 61.9, p=0.79), PSA (9.3 vs 8.1, p=0.11), and PSA density (0.19 vs 0.16, p=0.55) were similar for AA and W men. Abnormal DRE (15.5% vs 15.7%, p= 0.98) and previous biopsy status were similar (p=0.20) with 36.2% and 34.8% of AA and W noted to be biopsy naive, respectively. Overall, 109/173 (63.0%) of men had PIRADS â‰¥ 4 lesions and 62/173 (35.8%) men were found to have clinically significant PCa at biopsy with no significant difference noted between our cohorts (p=0.41, 0.68 respectively). Prostate mpMRI in AA and W men showed similar sensitivity (86.4% vs 80%, p=0.73), specificity (44.4% vs 49.3%, p=0.63), positive predictive value (48.7% vs 45.7%, p=0.76), and negative predictive value (84.2% vs 82.2%, p=1.00) for clinically significant PCa.
Conclusions: We found no significant differences in the predictive accuracy of prostate mpMRI for clinically significant PCa on biopsy between AA and W men. In the diagnostic setting, prostate MRI should not be offered preferentially on the basis of race.