Does previous prostate surgery affect multiparametric magnetic resonance imaging accuracy in detecting clinically significant prostate cancer? Results from a single institution series

Abstract

Background: Multiparametric MRI (mpMRI) has demonstrated high diagnostic accuracy for clinically significant PCa (csPCa). However, the accuracy of this test in men that received a previous prostatic surgery is still controversial. We aimed at assessing the effect of previous prostatic surgery on the detection of csPCa in a tertiary referral center. Method:We relied on a cohort of 311 men with a positive mpMRI (prostate imagingreporting and data system [PI-RADS] ≥ 3) who underwent a targeted (TBx) plus concomitant systematic random biopsy (SBx) at a single tertiary referral center between 2017 and 2020. The study outcome was to compare the detection of csPCa (Gleason score ≥ 3 + 4) between the two groups (no previous prostate surgery [Group 1] vs. previous prostate surgery [Group 2]). Multivariable logistic regression analysis (MVA) was used to assess the relationship between previous prostate surgery and the detection of csPCa at TBx, after taking into account potential clinical confounders.Results: Overall, 24 (8%) patients received a previous prostate surgery before undergoing mpMRI. Median prostate-specific antigen density was 0.15 versus 0.08 ng/ml/cc, in Group 1 versus 2, respectively. The most frequent finding at mpMRI was in Group 1 versus 2, PI-RADS 4 (55%) versus PI-RADS 3 and 4 (42% each). The majority of patients were biopsy naïve in both Groups 1 (66%) and 2 (71%). The overall detection of csPCa in Group 1 versus 2 was 83% versus 75%, respectively. Differently, the detection of csPCa at TBx in Groups 1 versus 2 was 76% versus 71%, respectively. At MVA, previous prostate surgery (odds ratio: 0.65; p = 0.02) was significantly associated with lower csPCa detection at TBx, after accounting for potential confounders.

Variability of mpMRI diagnostic performance according to the upfront individual patient risk of having clinically significant prostate cancer

“…Of note, we evaluated a homogeneous population of patients who underwent prostate biopsy at a single tertiary referral center using the same diagnostic pathway. For instance, all patients in our cohort underwent mpMRI using the same protocol, 7 MRI images were scored and reported by expert radiologist using the PI-RADS version 2, 8 all patients received prostate biopsy performed by expert urologists using the same technique, [9][10][11][12] and the histopathology processing and reporting was consistent during the study period and executed by expert uropathologists. 13,14 Prostate mpMRI is often used as a triage test and patients with PI-RADS ≥ 3 lesions, that are usually interpreted as a positive mpMRI findings, undergo biopsies indiscriminately.…”

“…The mpMRI images were scored and reported using the PI‐RADS version 2 by expert radiologists 8 . All patients underwent both TBx and SBx at our center according to the technique previously described 9–11 . TBx was performed using a software‐registration fusion approach and was immediately followed by additional random SBx using a sextant biopsy scheme during the same session, in accordance with the currently available guidelines 2 .…”

“…8 All patients underwent both TBx and SBx at our center according to the technique previously described. [9][10][11] TBx was performed using a software-registration fusion approach and was immediately followed by additional random SBx using a sextant biopsy scheme during the same session, in accordance with the currently available guidelines. 2 Biopsies were performed by experienced urologists using an 18-gauge needle and a biopsy gun providing a specimen size of 18−22 mm.…”

The Impact of Multiparametric Magnetic Resonance Imaging on Treatment Strategies for Incidental Prostate Cancer after Holmium Laser Enucleation of the Prostate

“…The results of our study show that mpMRI can be used for the risk stratification of iPCa after HoLEP; however, there are some caveats with respect to interpretation of mpMRI findings after HoLEP. First, changes in the normal anatomical structure after HoLEP, such as gland deformity or residual adenoma, can make interpretation of mpMRI difficult, confounding the distinction from csPCa [28]. Second, hemorrhage inside the prostate can reduce the T2 signal intensity, making it difficult to distinguish it from PCa.…”

“…In our study, we tried to reduce the ambiguity of interpretation by leaving an interval of 3 months from HoLEP to mpMRI. As a whole, when interpreting mpMRI after prostate surgery, it should be considered that the risk of csPCa may be about 5-10% lower than that of naïve prostate [28].…”