What is the negative predictive value of multiparametric MRI in excluding clinically significant prostate cancer at biopsy? Results from 1000 pre-biopsy multiparametric MRIs.
BAUS ePoster online library. Lobo N. Jun 24, 2019; 259551; P5-7
Ms. Niyati Lobo
Ms. Niyati Lobo
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Abstract
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INTRODUCTION

Pre-biopsy multiparametric MRI (mpMRI) is reported to have a negative predictive value (NPV) of 89% in prostate cancer diagnosis. We determined the NPV of mpMRI alone and in combination with PSA density (PSAD) for significant prostate cancer (sPCa) in men undergoing prostate biopsy at our institution.

Material and methods

We identified 1000 biopsy-naive patients undergoing 1.5T or 3T pre-biopsy mpMRI from October 2015 to September 2018. All scans were reported by 2 uro-radiologists using PIRADS v 2 with negative mpMRI defined as PIRADS <3. Men with negative mpMRI underwent a minimum of 12-core systematic transrectal ultrasound-guided biopsy. sPCa was defined as Gleason score ≥3+4.The Mann-Whitney test, univariable and multivariable Cox regression models were performed for statistical analysis.

RESULTS

Of 1000 patients, 44% (n=444) had negative mpMRI. Prostate cancer and sPCa was detected in 35% (n=155) and 15% (n=66), corresponding to a NPV of 65% and 85% respectively. Using a PSAD cut-off of 0.15 ng/ml/ml and 0.10 ng/ml/ml in combination with a negative mpMRI increased the NPV for sPCA to 89% and 91% respectively. Patients with sPCa had smaller prostate volumes (p<0.001) and higher PSAD (p<0.001) than non-sPCa patients. On univariate analysis, prostate volume (p<0.001) and increasing PSAD (p<0.001) were predictors for sPCa. On multivariable analyses, only PSA density was a predictor for sPCA.

CONCLUSION

A negative pre-biopsy mpMRI can reliably exclude significant prostate cancer when used in combination with a low PSA density. However, a small number of significant cancers will be missed.
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