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Updated: Jul 12, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Multiparametric Magnetic Resonance Imaging in Prostate Cancer Screening at the Age of 45 Years: Results from the
Matthias Boschheidgen1, Peter Albers2, Heinz-Peter Schlemmer3
1Dusseldorf University, Medical Faculty, Department of Diagnostic and Interventional Radiology, D-40225 Dusseldorf, Germany.
Background:
Magnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening.
Objective:
To determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA).
Design, Setting, And Participants:
Participants with confirmed PSA ≥3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4).
Results And Limitations:
Of 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group ≥2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS <3. If PI-RADS ≥4 were to be used as a biopsy cutoff, mpMRI would reduce negative biopsies by 68% and avoid detection of nonsignificant PC in 71% of cases.
Conclusions:
Prostate MRI in a young screening population is difficult to read. The MRI accuracy of for csPC detection is highly dependent on reader experience, and double reading might be advisable. More data are needed before MRI is included in PC screening for men at age 45 yr.
Patient Summary:
Measurement of prostate specific antigen (PSA) is an effective screening test for early detection of prostate cancer (PC) and can reduce PC-specific deaths, but it can also lead to unnecessary biopsies and treatment. Magnetic resonance imaging (MRI) after a positive PSA test has been proposed as a way to reduce the number of biopsies, with biopsy only recommended for men with suspicious MRI findings. Our results indicate that MRI accuracy is moderate for men aged 45 years but can be increased by a second reading of the images by expert radiologists. For broad application of MRI in routine screening, double reading may be advisable.
Insights
Multiparametric MRI (mpMRI) shows moderate accuracy for prostate cancer detection in 45-year-old men. Expert double reading of mpMRI scans can improve accuracy, potentially reducing unnecessary biopsies in prostate cancer screening.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Prostate cancer (PC) screening using prostate-specific antigen (PSA) can lead to unnecessary biopsies and treatment.
- Multiparametric MRI (mpMRI) is being investigated as a tool to guide biopsy decisions in PC screening.
Purpose of the Study:
- To evaluate the performance of mpMRI in detecting clinically significant PC (csPC) in young men (age 45) participating in the PROBASE screening trial.
- To assess the impact of reader experience and double reading on mpMRI accuracy for PC detection.
Main Methods:
- 114 men aged 45 with elevated PSA (≥3 ng/ml) underwent mpMRI followed by MRI/transrectal ultrasound fusion biopsy.
- mpMRI scans were interpreted by local readers and then by two experienced reference radiologists, blinded to histopathology.
- Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and sensitivity, negative predictive value (NPV), and accuracy were calculated.
Main Results:
- PC was detected in 41% of participants, with 29% having csPC.
- Reference radiologists achieved higher accuracy (85%) for csPC detection at PI-RADS 4 cutoff compared to local readers (68%).
- Using PI-RADS ≥4 as a biopsy cutoff could reduce negative biopsies by 68% and avoid detecting non-significant PC in 71% of cases.
Conclusions:
- mpMRI interpretation in young screening populations is challenging and highly dependent on reader experience.
- Double reading by expert radiologists may enhance diagnostic accuracy for csPC detection.
- Further research is needed before incorporating mpMRI into routine PC screening for 45-year-old men.
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