Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project

Matthijs J Scheltema ,M Pilar Laguna ,Arnoud W Postema ,Georg Salomon ,Nelson N Stone ,Arnauld Villers ,Shyam Natarajan ,John F Feller ,Frank Kahmann ,Arvin George ,Soroush Rais‐Bahrami ,Jochen Walz ,Robert Villani ,Theo M De Reijke ,Kae Jack Tay ,Rajan T Gupta ,Christof Kastner ,Thomas J Polascik ,Roland Van Velthoven ,Ardeshir R Rastinehad ,Jurgen J Fütterer ,Daniël M De Bruin ,Jean J.m.c.h De La Rosette

doi:10.1007/s00345-016-1932-1

Abstract

PurposeTo codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT).MethodsAn international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results.ResultsmpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers.ConclusionsThe mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community.

Highlights

Recent technological advancements in multiparametric magnetic resonance imaging have resulted in improved detection of clinically significant prostate cancer (PCa) and are increasingly used in urological practice and for focal therapy (FT)
Most excellent results on multiparametric magnetic resonance imaging (mpMRI) PCa detection are published by expert centers where the quality of the mpMRI is assured by standardized acquisition, interpretation and image-pathology feedback
A recent systematic review of available literature on the detection of significant PCa by mpMRI showed that the negative predictive value (NPV) ranged from 63 to 98 % [6]; the majority of the included studies used prostate biopsies for histopathological validation

Summary

Introduction

Recent technological advancements in multiparametric magnetic resonance imaging (mpMRI) have resulted in improved detection of clinically significant prostate cancer (PCa) and are increasingly used in urological practice and for focal therapy (FT). When comparing mpMRI and pathology following radical prostatectomy (sliced by use of a customized 3D mold), the positive predictive value (PPV) for the detection of PCa in the peripheral zone, central zone and overall prostate was 98, 100 and 98 %, respectively, whereas the negative predictive value (NPV) was 90 % for all mpMRI sequences [2]. In another series, the positive and negative predictive values were 86 and 85 % for lesions >0.2 mL and 77 and 95 % for lesions >0.5 mL [3]. A recent systematic review of available literature on the detection of significant PCa by mpMRI showed that the NPV ranged from 63 to 98 % [6]; the majority of the included studies used prostate biopsies for histopathological validation

Methods

Results

Conclusion