Abstract
Risk-based patient selection for systematic biopsy in prostate cancer diagnosis has been adopted in daily clinical practice, either by clinical judgment and PSA testing, or using multivariate risk prediction tools. The use of multivariable risk prediction tools can significantly reduce unnecessary systematic biopsies, without compromising the detection of clinically significant disease. Increasingly multi-parametric magnetic resonance imaging (MRI) is performed, not only in men with a persistent suspicion of prostate cancer after prior negative systematic biopsy, but also at initial screening before the first biopsy. The combination of MRI and multivariate risk prediction tools could potentially enhance prostate cancer diagnosis using multivariate MRI incorporated risk-based models to decide on the need for prostate MRI, but also using MRI results to adjusted risk-based models, and to guide MRI-directed biopsies. In this review, we discuss the diagnostic work-up for clinically significant prostate cancer, where the combination of MRI and multivariate risk prediction tools is integrated, and how together they can contribute to personalized diagnosis.
Highlights
Magnetic resonance imaging (MRI) is an increasingly useful tool for clinically significant prostate cancer detection and has recently come to the forefront in the diagnostic work-up in many countries [1,2,3]
A systematic biopsy is strongly recommended, based on the ERSPC-RC#3
Based on high yields of clinically significant prostate cancer (> 70%) in an MRI lesion with a PI-RADS assessment score 5 (Sect. 3.2 and 4.2) [37], a targeted biopsy is strongly recommended in this biopsy-naïve man
Summary
Magnetic resonance imaging (MRI) is an increasingly useful tool for clinically significant prostate cancer detection and has recently come to the forefront in the diagnostic work-up in many countries [1,2,3]. When multivariate risk prediction tools indicate that risk is not high enough to perform a biopsy or MRI, avoiding MRI will result in limiting the false-positive outcomes of MRI testing [42], and, reduce the number of biopsies undertaken This means that some clinically significant cancers will not be immediately diagnosed (just as in the pre-MRI era but with lesser frequency), requiring robust follow-up regimens to catch emerging over time. (4) The chance of finding any prostate cancer and clinically significant prostate cancer with further testing is 70% and 45%, respectively, based on the MRI-ERSPC-RC#3, including PSA, DRE, TRUS, TRUS volume, and MRI PI-RADS score [49] (c) In this man, a systematic and targeted biopsy is advised. In men with PI-RADS category 3 or small category 4 prostate lesions, the combined use of elevated risk-calculator findings and MRI location information may indicate the need for using MRI-targeted and systematic biopsy approaches to gain maximal diagnostic yields.
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