A Report on the Use of Biparametric MRI in Prostate Cancer Diagnosis: A Two-Year Single Centre Experience

The use of pre-biopsy MRI scans is now a standard of care in the evaluation of men with elevated prostate-specific antigen (PSA); however, the use of biparametric MRI (bpMRI) has been a source of controversy amongst health professionals. The study aimed to analyse our experience with the use of bpMRI in evaluating suspected prostate cancer in conjunction with other clinical indicators, such as PSA density (PSAD) and family history of prostate cancer.

This retrospective, single-centre study consisted of 404 patients who had an MRI due to elevated PSA and subsequent prostate biopsies.

The average age of the study population was 69.7±7.3 years, with the majority of the patients above 70 years. A statistically significant positive correlation was observed between PSAD and Prostate Imaging-Reporting and Data System (PI-RADS) scores (r=0.2, p<0.001). Higher PSAD groups showed an increased proportion of PI-RADS 4 and 5 lesions. There was a significant positive correlation (r=0.2, p<0.001) between PSAD and International Society of Urological Pathology (ISUP) grade, indicating that the detection of clinically significant and higher-grade prostate cancer increases with PSAD. High-risk prostate cancers (ISUP grades 4 and 5) were detected in the high-risk category of PSAD (14.6% and 18%, respectively). PI-RADS scores correlated significantly with ISUP grades (r=0.3, p<0.001).  Conclusion: Our study demonstrated that bpMRI-detected PI-RADS scores significantly correlated with PSAD, histological diagnosis (ISUP grade), and clinically significant prostate cancer detection. bpMRI has a role in the diagnostic value of prostate cancer when combined with PSAD and a family history of prostate cancer. It is effective in detecting clinically significant prostate cancers at a lower cost and shorter time while eliminating the potential harm of the use of gadolinium.