The role of negative magnetic resonance imaging: can we safely avoid biopsy in P.I.-R.A.D.S. 2 as in P.I.-R.A.D.S. 1?

Regis, Lucas; Celma, A.; Planas, Jacques; Lopez, Ricardo; Roche, S.; Lorenté, David; Placer, J.; Trilla, Enrique; Moróte, Juan

doi:10.1080/21681805.2018.1551243

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…28 Furthermore, SII and SII combination with PI-RADS score have been reported as a significant diagnostic marker in patients with high-grade PCa (ISUP grade 3-5). 29 In contrast to these earlier findings, we did not find association between these parameters and the result of saturation biopsy. Some controversy remains as to whether patients with prostate cancer suspicion and negative MRI can safely omit biopsy.…”

Section: Dovepresscontrasting

confidence: 99%

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Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

Medina¹,

Rodríguez²,

Hernández³

et al. 2021

RRU

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Purpose Prostatic multi-parametric magnetic resonance imaging (mpMRI) has markedly improved the assessment of men with suspected prostate cancer (PCa). Nevertheless, as mpMRI exhibits a high negative predictive value, a negative MRI may represent a diagnostic dilemma. The aim of this study was to evaluate the incidence of positive transperineal saturation biopsy in men who have negative mpMRI and to analyse the factors associated with positive biopsy in this scenario. Patients and Methods A retrospective study of men with normal mpMRI and suspicion of PCa who underwent saturation biopsy (≥20 cores) was carried out. A total of 580 patients underwent transperineal MRI/transrectal ultrasound fusion targeted biopsies or saturation prostate biopsies from January 2017 to September 2020. Of them, 73 had a pre-biopsy negative mpMRI (with Prostate Imaging – Reporting and Data System, PI-RADS, ≤2) and were included in this study. Demographics, clinical characteristics, data regarding biopsy results and potential predictive factors of positive saturation biopsy were collected. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for MRI-invisible PCa. Results The detection rate of PCa with saturation biopsy in patients with negative MRI was 34/73 (46.58%). Out of 34 MRI-invisible prostate cancers detected, 12 (35.29%) were clinically significant PCa (csPCa) forms. Regarding factors of positive biopsy, in univariate analysis, the use of 5-alpha reductase inhibitors and free:total prostate-specific antigen (PSA) ratio were associated with the result of the saturation biopsy. In multivariate analysis, only an unfavourable free:total PSA ratio remained a risk factor (OR 11.03, CI95% 1.93–63.15, p=0.01). Furthermore, multivariate logistic analysis demonstrated that prostate volume >50mL significantly predicts the absence of csPCa on saturation biopsy (OR 0.11, 95% CI 0.01–0.94, p=0.04). Conclusion A free:total PSA ratio <20% is a risk factor for MRI-invisible PCa. Saturation biopsy could be considered in patients with suspected PCa, despite having a negative MRI.

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Section: Dovepresscontrasting

confidence: 99%

“…Regis et al have stated categorically that PI-RADS 2 should not be considered as a negative MRI because its NPV in biopsy-naïve patients was 84%. 30 In consonance with this author, Ma et al considered that only PI-RADS 1 has a high NPV. 31 …”

Section: Discussionmentioning

confidence: 80%

Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

Medina¹,

Rodríguez²,

Hernández³

et al. 2021

RRU

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“…At our medical center, 15.65% (216 eligible patients out of 1380 overall) between 2018 and 2020 showed negative mpMRI, from which 75% received prostate biopsy with only 5.1% of them showing clinically significant prostate cancer. Previous studies showed negative predictive values (NPV) of mpMRI, ranging from 76 to 99% [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Thus, the negative prognostic value of mpMRI at our institute is sufficient and congruent to other data.…”

Section: Discussionsupporting

confidence: 86%

Negative multiparametric magnetic resonance imaging for prostate cancer: further outcome and consequences

et al. 2022

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Purpose EAU guidelines recommend multiparametric MRI of the prostate (mpMRI) prior to biopsy to increase accuracy and reduce biopsies. Whether biopsy can be avoided in case of negative mpMRI remains unclear. Aim of this study is to evaluate predictors of overall prostate cancer (PCa) in negative mpMRI. Methods A total of 216 patients from 2018 to 2020 with suspicion of PCa and negative mpMRI (PI-RADS ≤ 2) were interviewed by telephone about outcome and further follow-up. Clinically significant PCa (csPCa) was defined as ISUP ≥ 2. Patients with vs. without biopsy and with vs. without PCa were compared. Univariate and multivariate analyses were performed to evaluate predictors of PCa occurrence in patients with negative mpMRI. Results 15.7% and 5.1% of patients with PI-RADS ≤ 2 on mpMRI showed PCa and csPCa, respectively. PCa patients had higher PSAD (0.14 vs. 0.09 ng/ml2; p = 0.001) and lower prostate volume (50.5 vs. 74.0 ml; p = 0.003). Patients without biopsy (25%) after MRI were older (69 vs. 65.5 years; p = 0.027), showed lower PSA (5.7 vs. 6.73 ng/ml; p = 0.033) and lower PSA density (0.09 vs. 0.1 ng/ml2; p = 0.027). Multivariate analysis revealed age (OR 1.09 [1.02–1.16]; p = 0.011), prostate volume (OR 0.982 [0.065; 0.997]; p = 0.027), total PSA level (OR 1.22 [1.01–1.47], p = 0.033), free PSA (OR 0.431 [0.177; 0.927]; p = 0.049) and no PI-RADS lesion vs PI-RADS 1–2 lesion (OR 0.38 [0.15–0.91], p = 0.032.) as predictive factors for the endpoint presence of PCa. Conclusions Biopsy for selected patient groups (higher age, prostate volume and free PSA as well as lower PSA-Density) with negative mpMRI can be avoided, if sufficient follow-up care is guaranteed. Detailed counseling regarding residual risk for undetected prostate cancer should be mandatory.

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“…Even with long-term follow-up (median 6.7 years), the NPV remained at 96% [20]. Subgroups of patients with previous history of negative biopsy in studies reporting the results of mixed populations showed respective NPVs of 83.3%, 92%, 97%, 100% and 100% [21][22][23][24][25].…”

Section: Prior Negative Biopsymentioning

confidence: 94%

“…Two recent retrospective studies including 222 and 391 cancer-naïve patients with non-suspicious mpMRIs reported NPVs of 96% and 89.8%, respectively [21,26] . Interestingly, in the second study by De Visschere and colleagues, only 47% of mpMRIs were still classified as non-suspicious in retrospect, in light of clinical data revealing a diagnosis of prostate cancer at 2-year follow-up in 124/391 (32%) patients [26].…”

Section: Mixed Populationsmentioning

confidence: 99%

What to expect from a non-suspicious prostate MRI? A review

Fiard

Norris

Nguyen

et al. 2020

Progrès en Urologie

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Abbreviations mpMRI Multiparametric Magnetic Resonance Imaging NPV Negative Predictive Value Résumé Contexte : La réalisation d'une IRM multiparamétrique (IRMmp) est désormais recommandée avant la réalisation de biopsies prostatiques. En revanche, la conduite à tenir en présence d'une IRMmp non-suspecte (Score Likert ou PIRADS 1-2) est toujours débattue. Objectifs : Faire une synthèse de la littérature récente pour répondre à trois questions. 1) Faut-il réaliser des biopsies systématisées en présence d'une IRMmp non suspecte ? 2) Quels facteurs prédictifs permettent de définir les patients candidats à une biopsie systématisée ? 3) Le manque de visibilité de certains cancers peut-elle être expliquée et quelles en sont les conséquences cliniques ? Sources : Une revue narrative de la littérature a été réalisée à partir des bases de données Medline utilisant deux recherches avec les termes "MRI" AND "prostate cancer" AND ("diagnosis" OR "biopsy") AND ("non-suspicious" OR "negative" OR "invisible") ; "prostate cancer MRI visible". Les références des articles sélectionnés ont été analysées à la recherche d'articles supplémentaires. Sélection des études : Les études publiées dans les 5 dernières années en anglais ont été analysées et retenues si les données disponibles permettaient de répondre à l'une des 3 questions posées. Résultats : Considérant les cancers de grade ISUP ³ 2 cliniquement significatifs, la valeur prédictive négative (VPN) de l'IRMmp était comprise entre 76% et 99%, dépendante de la prévalence du cancer et du type de test de référence utilisé. La VPN était plus élevée chez les patients aux antécédents de biopsie négative (88-96%), et plus faible chez les patients en surveillance active (85-90%). La densité de PSA (PSAd) avec un seuil de PSAd<0.15ng/ml/ml était le facteur prédictif le plus étudié et le plus pertinent associé à l'IRMmp pour éliminer un cancer significatif. Enfin, les tumeurs non visibles à l'IRMmp présentaient des différences au niveau histopathologique et génétique, conférant un intérêt clinique à la visibilité IRM. Limites du travail : La plupart des données proviennent de centres experts et les résultats peuvent ne pas être reproductibles en dehors. Conclusion : L'IRMmp fait preuve de performances diagnostiques élevées pour éliminer un cancer cliniquement significatif. La densité de PSA peut être utilisée pour sélectionner patients devant avoir une biopsie. Une meilleure connaissance des mécanismes à l'origine de la visibilité du cancer devrait aider le développement de nomogrammes et biomarqueurs plus précis.

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The role of negative magnetic resonance imaging: can we safely avoid biopsy in P.I.-R.A.D.S. 2 as in P.I.-R.A.D.S. 1?

Cited by 4 publications

References 29 publications

Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

Negative multiparametric magnetic resonance imaging for prostate cancer: further outcome and consequences

What to expect from a non-suspicious prostate MRI? A review

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