Skip to main content
Erschienen in:

23.01.2020 | Pelvis

Can multiparametric magnetic resonance of the prostate avoid biopsies in patients with elevated PSA and surgical indication for benign prostatic enlargement?

verfasst von: Marcelo Langer Wroclawski, Paulo Priante Kayano, Breno Santos Amaral, Guilherme Cayres Mariotti, Fernando Ide Yamauchi, Jonathan Doyun Cha, Arie Carneiro, Fernando Korkes, Alessandra Sousa Vitalli, Thais Caldara Mussi, Gustavo Caserta Lemos, Ronaldo Hueb Baroni

Erschienen in: Abdominal Radiology | Ausgabe 10/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction

To evaluate the clinical dilemma of men with surgical indication due to benign prostatic enlargement (BPE) and concomitant elevated PSA, we analysed if multiparametric magnetic resonance imaging (mpMRI) could safely prescind the prostate biopsy.

Methods

Forty men with surgical indication due to BPE and concomitantly elevated PSA levels were prospectively enrolled and retrospectively analysed. All patients underwent 1.5 Tesla mpMRI prior to TRUS-guided biopsies. In cases where mpMRI was PIRADS 3 with focal lesions, PIRADS 4 or PIRADS 5, additional fragments were obtained with the fusion guided technique. Biopsy histopathological results were used as the standard of reference.
Two scenarios were evaluated: scenario 1, considering mpMRI PIRADS 1 and 2 as negative; and scenario 2, considering PIRADS 1, 2 and 3 as negative. Clinically significant prostate cancer (CsPCa) was defined as ISUP ≥ 2.

Results

Median age was 68 years, median PSA was 9.41 (6.40–19.54) and median prostatic volume was 116.5 cc (IQR 86.5–155).
Scenario 1 mpMRI sensitivity, specificity, PPV, NPV and accuracy for any prostate cancer on prostate biopsy was 76.9%, 63%, 50%, 85% and 67.5%. For csPCa, they were 87.5%, 59.4%, 35%, 95% and 65%, respectively, for the same measures.
Scenario 2 the sensitivity, specificity, PPV, NPV and accuracy of mpMRI for any prostate cancer on prostate biopsy was 53.8%, 96.3%, 87.5%, 81.3% and 82.5%. For csPCa, they were 75%, 93.8%, 75%, 93.8% and 90%, respectively, for the same measures.

Conclusion

Prostate mpMRI may prevent unnecessary biopsies in patients with elevated PSA and surgical indications due to BPE, given its high negative predictive value.
Literatur
1.
Zurück zum Zitat Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology. 2002;59(6):877-83. Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology. 2002;59(6):877-83.
2.
Zurück zum Zitat Wroclawski ML, Carneiro A, Tristao RA, Sakuramoto PK, Youssef JD, Lopes Neto AC, et al. Giant prostatic hyperplasia: report of a previously asymptomatic man presenting with gross hematuria and hypovolemic shock. Einstein (Sao Paulo). 2015;13(3):420-2.CrossRef Wroclawski ML, Carneiro A, Tristao RA, Sakuramoto PK, Youssef JD, Lopes Neto AC, et al. Giant prostatic hyperplasia: report of a previously asymptomatic man presenting with gross hematuria and hypovolemic shock. Einstein (Sao Paulo). 2015;13(3):420-2.CrossRef
3.
Zurück zum Zitat Catalona WJ, Southwick PC, Slawin KM, Partin AW, Brawer MK, Flanigan RC, et al. Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. Urology. 2000;56(2):255-60.CrossRef Catalona WJ, Southwick PC, Slawin KM, Partin AW, Brawer MK, Flanigan RC, et al. Comparison of percent free PSA, PSA density, and age-specific PSA cutoffs for prostate cancer detection and staging. Urology. 2000;56(2):255-60.CrossRef
4.
Zurück zum Zitat Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-77.CrossRef Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-77.CrossRef
5.
Zurück zum Zitat Rosenkrantz AB, Kim S, Lim RP, Hindman N, Deng FM, Babb JS, et al. Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales. Radiology. 2013;269(2):482-92.CrossRef Rosenkrantz AB, Kim S, Lim RP, Hindman N, Deng FM, Babb JS, et al. Prostate cancer localization using multiparametric MR imaging: comparison of Prostate Imaging Reporting and Data System (PI-RADS) and Likert scales. Radiology. 2013;269(2):482-92.CrossRef
6.
Zurück zum Zitat Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016;40(2):244-52. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016;40(2):244-52.
7.
Zurück zum Zitat Catalona WJ, Smith DS, Wolfert RL, Wang TJ, Rittenhouse HG, Ratliff TL, et al. Evaluation of percentage of free serum prostate-specific antigen to improve specificity of prostate cancer screening. Jama. 1995;274(15):1214-20.CrossRef Catalona WJ, Smith DS, Wolfert RL, Wang TJ, Rittenhouse HG, Ratliff TL, et al. Evaluation of percentage of free serum prostate-specific antigen to improve specificity of prostate cancer screening. Jama. 1995;274(15):1214-20.CrossRef
8.
Zurück zum Zitat Partin AW, Brawer MK, Subong EN, Kelley CA, Cox JL, Bruzek DJ, et al. Prospective evaluation of percent free-PSA and complexed-PSA for early detection of prostate cancer. Prostate Cancer Prostatic Dis. 1998;1(4):197-203.CrossRef Partin AW, Brawer MK, Subong EN, Kelley CA, Cox JL, Bruzek DJ, et al. Prospective evaluation of percent free-PSA and complexed-PSA for early detection of prostate cancer. Prostate Cancer Prostatic Dis. 1998;1(4):197-203.CrossRef
9.
Zurück zum Zitat Carter HB, Ferrucci L, Kettermann A, Landis P, Wright EJ, Epstein JI, et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst. 2006;98(21):1521-7.CrossRef Carter HB, Ferrucci L, Kettermann A, Landis P, Wright EJ, Epstein JI, et al. Detection of life-threatening prostate cancer with prostate-specific antigen velocity during a window of curability. J Natl Cancer Inst. 2006;98(21):1521-7.CrossRef
10.
Zurück zum Zitat Nam RK, Toi A, Klotz LH, Trachtenberg J, Jewett MA, Appu S, et al. Assessing individual risk for prostate cancer. J Clin Oncol. 2007;25(24):3582-8.CrossRef Nam RK, Toi A, Klotz LH, Trachtenberg J, Jewett MA, Appu S, et al. Assessing individual risk for prostate cancer. J Clin Oncol. 2007;25(24):3582-8.CrossRef
11.
Zurück zum Zitat Ankerst DP, Hoefler J, Bock S, Goodman PJ, Vickers A, Hernandez J, et al. Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer. Urology. 2014;83(6):1362-7. Ankerst DP, Hoefler J, Bock S, Goodman PJ, Vickers A, Hernandez J, et al. Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer. Urology. 2014;83(6):1362-7.
12.
Zurück zum Zitat Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027-35.CrossRef Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384(9959):2027-35.CrossRef
13.
Zurück zum Zitat Aminsharifi A, Howard L, Wu Y, De Hoedt A, Bailey C, Freedland SJ, et al. Prostate Specific Antigen Density as a Predictor of Clinically Significant Prostate Cancer When the Prostate Specific Antigen is in the Diagnostic Gray Zone: Defining the Optimum Cutoff Point Stratified by Race and Body Mass Index. J Urol. 2018;200(4):758-66.CrossRef Aminsharifi A, Howard L, Wu Y, De Hoedt A, Bailey C, Freedland SJ, et al. Prostate Specific Antigen Density as a Predictor of Clinically Significant Prostate Cancer When the Prostate Specific Antigen is in the Diagnostic Gray Zone: Defining the Optimum Cutoff Point Stratified by Race and Body Mass Index. J Urol. 2018;200(4):758-66.CrossRef
14.
Zurück zum Zitat Mussi TC, Garcia RG, Queiroz MR, Lemos GC, Baroni RH. Prostate cancer detection using multiparametric 3–tesla MRI and fusion biopsy: preliminary results. Int Braz J Urol. 2016;42(5):897-905.CrossRef Mussi TC, Garcia RG, Queiroz MR, Lemos GC, Baroni RH. Prostate cancer detection using multiparametric 3–tesla MRI and fusion biopsy: preliminary results. Int Braz J Urol. 2016;42(5):897-905.CrossRef
15.
Zurück zum Zitat Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815-22.CrossRef Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet. 2017;389(10071):815-22.CrossRef
16.
Zurück zum Zitat Truong H, Logan J, Turkbey B, Siddiqui MM, Rais-Bahrami S, Hoang AN, et al. MRI characterization of the dynamic effects of 5alpha-reductase inhibitors on prostate zonal volumes. Can J Urol. 2013;20(6):7002-7.PubMed Truong H, Logan J, Turkbey B, Siddiqui MM, Rais-Bahrami S, Hoang AN, et al. MRI characterization of the dynamic effects of 5alpha-reductase inhibitors on prostate zonal volumes. Can J Urol. 2013;20(6):7002-7.PubMed
17.
Zurück zum Zitat Kim JK, Lee HJ, Hwang SI, Choe G, Kim HJ, Hong SK. The effect of 5 alpha-reductase inhibitor therapy on prostate cancer detection in the era of multi-parametric magnetic resonance imaging. Sci Rep. 2019;9(1):17862.CrossRef Kim JK, Lee HJ, Hwang SI, Choe G, Kim HJ, Hong SK. The effect of 5 alpha-reductase inhibitor therapy on prostate cancer detection in the era of multi-parametric magnetic resonance imaging. Sci Rep. 2019;9(1):17862.CrossRef
18.
Zurück zum Zitat Panebianco V, Barchetti G, Simone G, Del Monte M, Ciardi A, Grompone MD, et al. Negative Multiparametric Magnetic Resonance Imaging for Prostate Cancer: What’s Next? Eur Urol. 2018;74(1):48-54.CrossRef Panebianco V, Barchetti G, Simone G, Del Monte M, Ciardi A, Grompone MD, et al. Negative Multiparametric Magnetic Resonance Imaging for Prostate Cancer: What’s Next? Eur Urol. 2018;74(1):48-54.CrossRef
19.
Zurück zum Zitat Oishi M, Shin T, Ohe C, Nassiri N, Palmer SL, Aron M, et al. Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer? J Urol. 2019;201(2):268-76.CrossRef Oishi M, Shin T, Ohe C, Nassiri N, Palmer SL, Aron M, et al. Which Patients with Negative Magnetic Resonance Imaging Can Safely Avoid Biopsy for Prostate Cancer? J Urol. 2019;201(2):268-76.CrossRef
20.
Zurück zum Zitat Moon DG, Yu JW, Lee JG, Kim JJ, Koh SK, Cheon J. The influence of prostate volume on the prostate-specific antigen (PSA) level adjusted for the transition zone volume and free-to-total PSA ratio: a prospective study. BJU Int. 2000;86(6):670-4.CrossRef Moon DG, Yu JW, Lee JG, Kim JJ, Koh SK, Cheon J. The influence of prostate volume on the prostate-specific antigen (PSA) level adjusted for the transition zone volume and free-to-total PSA ratio: a prospective study. BJU Int. 2000;86(6):670-4.CrossRef
Metadaten
Titel
Can multiparametric magnetic resonance of the prostate avoid biopsies in patients with elevated PSA and surgical indication for benign prostatic enlargement?
verfasst von
Marcelo Langer Wroclawski
Paulo Priante Kayano
Breno Santos Amaral
Guilherme Cayres Mariotti
Fernando Ide Yamauchi
Jonathan Doyun Cha
Arie Carneiro
Fernando Korkes
Alessandra Sousa Vitalli
Thais Caldara Mussi
Gustavo Caserta Lemos
Ronaldo Hueb Baroni
Publikationsdatum
23.01.2020
Verlag
Springer US
Erschienen in
Abdominal Radiology / Ausgabe 10/2020
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-020-02411-y

Neu im Fachgebiet Radiologie

Ab sofort gelten die neuen Verordnungsausnahmen für Lipidsenker

Freie Fahrt für Lipidsenker? Das nicht, doch mit niedrigerem Schwellenwert fürs Infarktrisiko und neuen Indikationen hat der G-BA die Verordnungs-Handbremse ein gutes Stück weit gelockert.

Abdominale CT bei Kindern: 40% mit Zufallsbefunden

Wird bei Kindern mit stumpfem Trauma eine CT des Bauchraums veranlasst, sind in rund 40% der Fälle Auffälligkeiten zu sehen, die nichts mit dem Trauma zu tun haben. Die allerwenigsten davon sind klinisch relevant.

Genügt die biparametrische MRT für die Prostatadiagnostik?

Die multiparametrische Magnetresonanztomografie hat einen festen Platz im Screening auf klinisch signifikante Prostatakarzinome. Ob auch ein biparametrisches Vorgehen ausreicht, ist in einer Metaanalyse untersucht worden.

Höhere Trefferquoten bei Brustkrebsscreening dank KI?

Künstliche Intelligenz unterstützt bei der Auswertung von Mammografie-Screenings und senkt somit den radiologischen Arbeitsaufwand. Wie wirken sich diese Technologien auf die Trefferquote und die Falsch-positiv-Rate aus? Das hat jetzt eine Studie aus Schweden untersucht.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.