Identifying Risk Factors for MRI-Invisible Prostate Cancer in Patients Undergoing Transperineal Saturation Biopsy

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Prostate multi-parametric magnetic resonance imaging (mpMRI) aids in diagnosing prostate cancer (PCa).
• A negative mpMRI result can create a diagnostic dilemma due to its high negative predictive value.
• Evaluating positive biopsy rates in men with negative mpMRI is crucial.

Purpose of the Study:

• To determine the incidence of positive transperineal saturation biopsy in men with negative mpMRI.
• To identify factors associated with positive biopsy results in this patient group.

Main Methods:

• Retrospective analysis of 73 men with suspected PCa and negative mpMRI (PI-RADS ≤2) who underwent saturation biopsy (≥20 cores).
• Collected demographics, clinical data, and biopsy results.
• Used univariate and multivariate logistic regression to find risk factors for MRI-invisible PCa.

Main Results:

• Prostate cancer was detected in 46.58% of men with negative mpMRI.
• Clinically significant PCa (csPCa) was found in 35.29% of detected cancers.
• An unfavorable free:total PSA ratio (<20%) was a significant risk factor (OR 11.03).
• Prostate volume >50mL predicted the absence of csPCa (OR 0.11).

Conclusions:

• Saturation biopsy can detect MRI-invisible prostate cancer in a significant proportion of men with suspected PCa.
• An unfavorable free:total PSA ratio (<20%) is a key risk factor for MRI-invisible PCa.
• Saturation biopsy should be considered for patients with suspected PCa even after a negative mpMRI.