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Updated: Apr 7, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
What kind of prostate cancers do we miss on multiparametric magnetic resonance imaging?
Pieter Julien Luc De Visschere1, Leslie Naesens2, Louis Libbrecht3
1Department of Radiology, Ghent University Hospital, 0 DPP, De Pintelaan 185, 9000, Gent, Belgium. pieter.devisschere@uzgent.be.
Objective:
To analyse the characteristics of prostate cancers (PrCa) detected following negative multiparametric magnetic resonance imaging (mpMRI).
Materials And Methods:
Eight hundred and thirty patients with elevated prostate-specific antigen (mean 11.9 μg/l) underwent mpMRI of the prostate at 1.5 Tesla with endorectal coil. The characteristics of all PrCa detected within 2 years after a negative mpMRI were analysed. Primary Gleason grade 4 or any grade 5 PrCa were considered high-grade (HG), Gleason score 3 + 4 intermediate grade (IG) and Gleason score ≤3 + 3 low-grade (LG). Tumour size was considered 'small' when <1 cm on radical prostatectomy specimen or limited to ≤2 cores on prostate biopsy.
Results:
mpMRI was negative in 391 patients (47.1 %). In 124 patients (31.7 %) PrCa was detected within 2 years. Eighty-four (67.7 %) were LG, 22 (17.7 %) IG and 18 (14.5 %) HG. 119 (96.0 %) of the missed PrCa were organ-confined. The negative predictive value was 95.4 % (373/391) for HG PrCa. Among the 18 missed HG PrCa, 15 (83.3 %) were organ-confined and 12 (66.6 %) were small.
Conclusion:
The majority of missed tumours on mpMRI were low grade and organ-confined. In patients with elevated PSA and a negative mpMRI, consideration could be given to continued surveillance rather than immediate biopsy.
Key Points:
• The majority of missed prostate cancers were low grade and organ-confined. • In patients with a negative mpMRI a biopsy may be postponed. • mpMRI had a negative predictive value of 95.4 % for high-grade prostate cancer.
Insights
Most prostate cancers missed by multiparametric MRI (mpMRI) are low-grade and organ-confined. A negative mpMRI result for prostate cancer may allow for continued surveillance instead of immediate biopsy, especially for high-grade disease.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Multiparametric magnetic resonance imaging (mpMRI) is increasingly used for prostate cancer (PrCa) detection.
- Elevated prostate-specific antigen (PSA) levels necessitate further investigation, often including mpMRI.
Purpose of the Study:
- To analyze the characteristics of prostate cancers (PrCa) detected after a negative mpMRI.
- To evaluate the performance of mpMRI in identifying high-grade PrCa.
Main Methods:
- 830 patients with elevated PSA underwent 1.5 Tesla mpMRI.
- Characteristics of PrCa detected within 2 years post-negative mpMRI were analyzed.
- Tumor grading (LG, IG, HG) and size were assessed.
Main Results:
- 47.1% of mpMRI scans were negative.
- PrCa was detected in 31.7% of patients within 2 years.
- Of the missed PrCa, 67.7% were low-grade (LG) and 96.0% were organ-confined.
- mpMRI had a 95.4% negative predictive value for high-grade PrCa.
Conclusions:
- The majority of prostate cancers missed by mpMRI are low-grade and organ-confined.
- A negative mpMRI may support surveillance over immediate biopsy in select cases.
- mpMRI demonstrates high accuracy in ruling out high-grade prostate cancer.
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