Multiparametric magnetic resonance imaging in prostate cancer detection

The prostate cancer screening based on systematic biopsies in patients with elevated PSA values has low sensitivity and low specificity. We assessed the use of multiparametric magnetic resonance imaging (mpMRI) as a screening tool for prostate cancer detection.

We retrospectively analyzed a cohort of patients with suspicious signs of prostate cancer who underwent prostate mpMRI before the biopsy. Patients underwent either targeted biopsy or systematic biopsy, depending on the presence or not of mpMRI lesions. Cancer diagnosis was confirmed from pathologic findings in biopsy samples.

The final record included 148 patients with a median of 3 previous negative biopsies (IQR 1-5).Cancer was diagnosed in 21 patients (14%); of them, 18 had highly suspicious mpMRI lesions (53% positive predictive value), 2 had lesions of other suspicion degree, and one had no mpMRI lesions. Cancer diagnosis was ruled out in 111 patients over 114 without highly suspicious mpMRI lesions (97% negative predictive value). In a multivariate analysis including PSA levels, abnormal DRE, the presence of mpMRI lesions, and the presence of highly suspicious mpMRI lesions, only the presence of highly suspicious mpMRI lesions significantly predicted cancer diagnosis.

The identification of highly suspicious lesions in prostate mpMRI examination has moderate sensitivity and high specificity in the detection of prostate cancer in patients with multiple previous negative biopsies. The use of mpMRI should be considered as a screening tool for prostate cancer in routine clinical practice.