Prospective nonrandomized study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy to magnetic resonance imaging with subsequent MRI-guided biopsy in biopsy-naïve patients

Abstract

Background: To evaluate the diagnostic efficacy in cancer prostate (PCa) of Multiparametric prostate magnetic resonance imaging (mp-MRI) targeted biopsy compared to standard systematic transrectal ultrasound-guided biopsy (TRUSGB) in biopsy-naïve patients.

Methods: A total of 168 biopsy-naïve men with clinical suspicion of PCa due to elevated PSA levels and/or an abnormal digital rectal examination were consecutively enrolled from July 2011 to July 2014. All patients underwent TRUSGB. Patients with equivocal (Pi-rads 3) or suspicious lesion (Pi-rads 4-5), were additionally biopsied using two cores, by the same operator (cognitive technique).

Results: Among the 168 cases, mp-MRI was equivocal for PCa (Pi-rads 3) in 46 subjects (27.4%) and suspicious (Pi-rads 4, 5) in 40 cases (23.8%). Of the 69 patients with PCa, standard TRUSGB showed Gleason ≥7 in 75% of patients with Pirads 3 and 77.8% in cases with Pirads 4-5 on mp-MRI. Among the 40 patients with Pi-rads 4-5 lesion on the MRI, cognitive mp-MRI-guided biopsy (MRCGB) detected a higher number of cases of PCa with a Gleason score equal or superior to 7 (90%) with a higher negative predictive value (97.5%) than cases with Pi-rads 3 lesion or subjects with TRUSGB alone.

Conclusions: mp-MRI followed by selective biopsy seems to be a valuable tool to improve the diagnosis of intermediate and high risk PCa compared to standard TRUSGB.