MP26-07 WHICH PROSTATE CANCERS ARE UNDETECTED BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN MEN WITH PRIOR PROSTATE BIOPSY? AN ANALYSIS FROM THE PICTURE STUDY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP26)1 Sep 2021MP26-07 WHICH PROSTATE CANCERS ARE UNDETECTED BY MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN MEN WITH PRIOR PROSTATE BIOPSY? AN ANALYSIS FROM THE PICTURE STUDY Joseph Norris, Lucy Simmons, Abi Kanthabalan, Alex Freeman, Neil McCartan, Caroline Moore, Shonit Punwani, Hayley Whitaker, Mark Emberton, Bloomsbury, and Hashim Ahmed Joseph NorrisJoseph Norris More articles by this author , Lucy SimmonsLucy Simmons More articles by this author , Abi KanthabalanAbi Kanthabalan More articles by this author , Alex FreemanAlex Freeman More articles by this author , Neil McCartanNeil McCartan More articles by this author , Caroline MooreCaroline Moore More articles by this author , Shonit PunwaniShonit Punwani More articles by this author , Hayley WhitakerHayley Whitaker More articles by this author , Mark EmbertonMark Emberton More articles by this author , Bloomsbury Bloomsbury More articles by this author , and Hashim AhmedHashim Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002023.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Not all significant cancers are detected by multiparametric magnetic resonance imaging (mpMRI), when risk stratifying for suspected prostate cancer in both biopsy-naïve men, and those with prior biopsy. In the PICTURE study (Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation) all men underwent validation using 5mm transperineal sampling, thus providing the ideal setting to investigate cancer undetected by mpMRI, in men requiring repeat biopsy. METHODS: PICTURE was a paired-cohort confirmatory study in which patients requiring repeat biopsy underwent mpMRI, followed by 5mm transperineal template mapping biopsy (TTPM biopsy). Outcomes were overall and maximum Gleason scores, maximum cancer core length (MCCL) and prostate specific antigen density (PSAD). Four definitions of cancer were considered. RESULTS: When non-suspicious mpMRI was defined as Likert 1–2, mpMRI overlooked 2.9% (3/103; 95%CI 0.6–8.3%) of PROMIS definition 1 disease (Gleason ≥4+3 of any amount or MCCL ≥6 mm of any grade), 6.5% (11/168; 95%CI 3.3–11%) of PROMIS definition 2 disease (Gleason ≥3+4 of any amount or MCCL ≥4mm of any grade), 4.8% (7/146; 95%CI 2.0–9.6%) with any Gleason ≥7, and 9.3% (20/215; 95%CI 5.8–14%) with any cancer. The most significant cancers undetected by mpMRI (i.e. definition 1) were significantly lower in overall (Table 1) and maximum Gleason grades than cancer that was detected (p=0.02 and p=0.01, respectively). Cancer undetected by mpMRI had significantly shorter MCCL than cancer that was detected, for every definition (p=0.02, p=0.04, p=0.03, and p=0.0009, respectively). Finally, using a PSAD threshold of 0.15ng/mL/mL with non-suspicious mpMRI lowered the proportion with undetected disease to 0% (0/105; 95% CI 0–3.5%) for definition 1, and to 0.58% (1/ 171; 95% CI 0.01–3.2%) for definition 2 cancer. CONCLUSIONS: Few clinically significant prostate cancers are undetected by mpMRI in men requiring repeat prostate biopsy. Undetected tumours are of lower overall and maximum Gleason grade and shorter cancer length, compared to those that are detected, reaffirming the role of mpMRI as a triage tool to determine who undergoes repeat biopsy. Source of Funding: Medical Research Council (MR/S00680X/1) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e464-e465 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Norris More articles by this author Lucy Simmons More articles by this author Abi Kanthabalan More articles by this author Alex Freeman More articles by this author Neil McCartan More articles by this author Caroline Moore More articles by this author Shonit Punwani More articles by this author Hayley Whitaker More articles by this author Mark Emberton More articles by this author Bloomsbury More articles by this author Hashim Ahmed More articles by this author Expand All Advertisement Loading ...