Ruling out clinically significant prostate cancer with negative multi-parametric MRI.

Area of Science:

• Radiology
• Oncology
• Urology

Background:

• Prostate cancer diagnosis often involves multi-parametric magnetic resonance imaging (mpMRI) and systematic biopsy.
• Evaluating the accuracy of negative mpMRI findings is crucial for patient management and avoiding overtreatment.

Purpose of the Study:

• To determine the negative predictive value (NPV) of a negative prostate multi-parametric magnetic resonance imaging (mpMRI) scan in excluding clinically significant prostate cancer (Gleason grade ≥7) detected by 12-core systematic biopsy.

Main Methods:

• A retrospective review of 114 men who underwent a 12-core systematic biopsy within one year of a negative prostate mpMRI.
• Calculation of the NPV for clinically significant prostate cancer.
• Regression analysis to identify predictors of biopsy outcomes.

Main Results:

• No cancer was detected in 77.2% of patients. Clinically significant cancer (Gleason ≥7) was found in only 3.6% of cases.
• The overall NPV for detecting Gleason ≥7 cancer was 96.5%.
• NPV was 100% in biopsy-naïve patients and those with prior negative biopsies, and 90% in patients on active surveillance after a previous positive biopsy.

Conclusions:

• Negative prostate mpMRI demonstrates a very low rate of clinically significant cancer on subsequent biopsy in this cohort.
• Most detected cancers were low-risk, suitable for active surveillance.
• Experienced radiologists interpreting negative mpMRI may help patients avoid unnecessary biopsies and overtreatment, though further validation is needed.