Reliability of prostate imaging reporting and data system version 2.1 for excluding clinically significant prostate...

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Multiparametric magnetic resonance imaging (mpMRI) is the recommended initial investigation for prostate cancer (PCa) detection.
• mpMRI helps identify patients needing biopsies for clinically significant PCa.
• It also helps patients with insignificant PCa avoid unnecessary invasive procedures and complications.

Purpose of the Study:

• To evaluate the reliability of omitting tissue sampling in men with a negative (PIRADS 2 or less) mpMRI in the primary diagnostic setting.
• To assess the accuracy of mpMRI in detecting clinically significant prostate cancer.

Main Methods:

• Retrospective study of patients with suspected PCa over a 2-year period.
• Patients underwent mpMRI prior to trans-perineal prostate biopsies.
• Clinically significant disease was defined as Gleason 7 and above; p-value < 0.05 was significant.

Main Results:

• Out of 700 patients, 90 had a PIRADS 2 score. Of these, 85.5% had negative biopsies, 10% showed Gleason 6, and 4% had Gleason 7 or above.
• 78 patients with PIRADS 2 and PSA density < 0.15 had no clinically significant biopsy results.
• The negative predictive value of mpMRI in this study was 95%.

Conclusions:

• The study's findings align with current literature on mpMRI's negative predictive values.
• mpMRI is a safe and reliable initial investigation for guiding prostate biopsy decisions.
• This local study's results are likely applicable to other district general hospitals.