The Diagnostic Performance of Multiparametric Magnetic Resonance Imaging to Detect Significant Prostate Cancer

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate cancer diagnosis relies on prostate-specific antigen (PSA) and digital rectal examination (DRE).
• Multiparametric MRI (mpMRI) is increasingly used to improve diagnostic accuracy before biopsy.

Purpose of the Study:

• To evaluate the accuracy of mpMRI in detecting significant prostate cancer (Gleason score ≥7) before biopsy.
• To assess mpMRI's performance in men with abnormal PSA/DRE findings.

Main Methods:

• 388 men with abnormal PSA/DRE underwent mpMRI (T2-weighted, DWI, DCE).
• Radiologists used PI-RADS scoring (1-5); scores 3-5 were positive.
• Transperineal template-guided mapping biopsy and MRI-targeted biopsy were performed.

Main Results:

• mpMRI was positive in 77%, detecting significant prostate cancer in 41.6% of analyzed patients.
• Sensitivity was 96%, specificity 36%, NPV 92%, PPV 52%.
• PI-RADS inclusion improved AUC from 0.776 to 0.879 (p<0.001); anatomical concordance was high.

Conclusions:

• mpMRI demonstrates excellent negative predictive value for significant prostate cancer detection.
• Moderate positive predictive value suggests potential for unnecessary biopsies.
• mpMRI aids in diagnosing significant prostate cancer, balancing detection rates and biopsy avoidance.