Pelvic phased-array mpMRI versus saturation biopsy: a diagnostic performance analysis in men with suspected advanced prostate cancer

Abstract

Objective: Saturation biopsy is more sensitive than transrectal biopsy in the detection of prostate cancer but is an invasive method and has a risk of overdiagnosis. Multiparametric magnetic resonance imaging (mpMRI) provides imaging and working information of the prostate. The purpose of the study was to compare the performance of pelvic phased-array mpMRI against saturation biopsies in men with suspected advanced prostate cancer considering pathology of the surgical specimen as the reference standard.Materials and methods: Data of men (n = 81) with prostate-specific antigen >10 ng/mL, low free-to-total ratio <0.1, and/or prostate-specific antigen density >0.15 who underwent mpMRI and saturation biopsy prior to radical prostatectomy were reviewed. The mpMRI was characterized as per Prostate Imaging Reporting and Data System v2.1. Gleason scores ≥3 + 4 were considered as prostate cancer. The beneficial score was evaluated for each diagnostic method for the decision-making of prostatectomy.Results: mpMRI was positive in 72 men, while saturated biopsies reported 57 men with positive prostate cancer. The histopathology of the surgical specimen reported prostate cancer in 76 men. mpMRI and saturated biopsies reported 0.934 and 0.737 sensitivities and 0.926 and 0.741 specificities, respectively. mpMRI had cancer detectability between 0.55 and 0.965 diagnostic confidence and saturation biopsies had cancer detectability between 0.85 and 0.952 diagnostic confidence. Above 0.965 and 0.952 diagnostic confidence, mpMRI and saturation biopsies had the risk of overdiagnosis.Conclusions: mpMRI can provide additional information for the detection of prostate cancer before saturation biopsies.Level of Evidence: III.