Abstract
ObjectivesThis study aims to prospectively estimate the diagnostic performance of multiparametric prostate MRI (mpMRI) and compare the detection rates of prostate cancer using cognitive targeted transrectal ultrasound (TRUS) guided biopsies, targeted MR-guided in-bore biopsies (MRGB), or both methods combined in biopsy-naïve men.MethodsThe biopsy-naïve men referred for mpMRI (including T2-weighted, diffusion-weighted and dynamic contrast enhanced MRI) due to prostate cancer suspicion (elevated prostate-specific antigen or abnormal digital rectal examination) were eligible for inclusion. The images were scored according to Prostate Imaging Reporting and Data System (PI-RADS) v2, and men with PI-RADS 1–2 lesions were referred for routine systematic TRUS, while those with PI-RADS 3–5 lesions were randomized to MRGB or cognitive targeted TRUS. Men randomized to MRGB were referred to a secondary TRUS 2 weeks after MRGB. Gleason grade group ≥2 was defined as clinically significant prostate cancer. The performance of mpMRI was estimated using prostate cancer detected by any biopsy method as the reference test.ResultsA total of 210 men were included. There was no suspicion of prostate cancer after mpMRI (PI-RADS 1–2) in 48% of the men. Among these, significant and insignificant prostate cancer was diagnosed in five and 11 men, respectively. Thirty-five men who scored as PI-RADS 1–2 did not undergo biopsy and were therefore excluded from the calculation of diagnostic accuracy. The overall sensitivity, specificity, negative predictive value, and positive predictive value of mpMRI for the detection of significant prostate cancer were 0.94, 0.63, 0.92, and 0.67, respectively. In patients with PI-RADS 3–5 lesions, the detection rates for significant prostate cancer were not significantly different between cognitive targeted TRUS (68.4%), MRGB (57.7%), and the combination of the two biopsy methods (64.4%). The median numbers of biopsy cores taken per patient undergoing systematic TRUS, cognitive targeted TRUS, and MRGB were 14 [8-16], 12 [6-17], and 2 [1-4] respectively.ConclusionsmpMRI, in a cohort of biopsy-naïve men, has high negative predictive value, and our results support that it is safe to avoid biopsy after negative mpMRI. Furthermore, MRGB provides a similar diagnosis to the cognitive targeted TRUS but with fewer biopsies.
Highlights
The introduction of multiparametric prostate MRI before biopsy has made an impact on how men referred to specialized healthcare services with suspicion of prostate cancer are stratified to biopsy strategies and further management [1]
There was no significant difference in cancer detection between the different biopsy pathways in this study
We show that MR-guided in-bore biopsy (MRGB) provides a similar diagnosis to the cognitive targeted transrectal ultrasound-guided biopsy (TRUS) but with fewer biopsies
Summary
The introduction of multiparametric prostate MRI (mpMRI) before biopsy has made an impact on how men referred to specialized healthcare services with suspicion of prostate cancer are stratified to biopsy strategies and further management [1]. Due to an increasing interest in targeted biopsy (MR guided in-bore biopsy or MR/TRUS fusion biopsy), the combination of mpMRI and targeted biopsy has the potential to increase the overall accuracy in the diagnostic pathway [2].The advantages of an initial mpMRI in men with a clinical suspicion of prostate cancer are well documented [3,4,5], but several questions remain to be answered in regard to when and how to biopsy. Should biopsy-naïve men be biopsied when mpMRI is negative for prostate cancer and should they have cognitive targeted TRUS biopsies with additional systematic biopsy cores (hereafter referred to as cognitive targeted TRUS biopsy), MR-guided in-bore biopsy (MRGB), or both (combined biopsy) when mpMRI is suspicious of prostate cancer?
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
