Determination of the Role of Negative Magnetic Resonance Imaging of the Prostate in Clinical Practice: Is Biopsy Still Necessary?

Published:November 11, 2016DOI:


      To assess the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI) for detection of prostate cancer (PCa) in routine clinical practice and to identify characteristics of patients for whom mpMRI fails to detect high-grade (Gleason score ≥7) disease.

      Materials and Methods

      We reviewed our prospectively maintained database of consecutive men who received prostate mpMRI at our institution, interpreted by a clinical practice of academic radiologists. Between January 2012 and December 2015, 84 men without any magnetic resonance imaging suspicious regions according to prior institutional classification, or with Prostate Imaging Reporting and Data System (PI-RADS) 1-2 lesions according to the PI-RADS system, underwent standard template transrectal ultrasound (TRUS)-guided prostate biopsy. Using these biopsy results, we calculated the NPV of mpMRI for the detection of PCa and identified patient risk factors for having a Gleason score ≥7 PCa on biopsy.


      High-grade PCa (Gleason score ≥7) was found on TRUS biopsy in 10.3% of biopsy-naive patients (NPV=89.7%), 16.7% of patients with previous negative biopsy (NPV=83.3%), and 13.3% of patients on active surveillance (NPV=86.6%). On multivariate analysis, the Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) estimated risk for high-grade PCa (as a continuous variable) was a significant predictor for high-grade PCa on biopsy (odds ratio 1.01, P < .01).


      Men with negative mpMRIs interpreted in a routine clinical setting have a significant risk of harboring Gleason score ≥7 PCa on a standard 12-region template biopsy, independent of indication. Standard template TRUS prostate biopsy should still be recommended for patients with negative mpMRI, particularly those with elevated PCPTRC estimated risk of high-grade PCa.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Weinreb J.C.
        • Barentsz J.O.
        • Choyke P.L.
        • et al.
        PI-RADS prostate imaging—reporting and data system: 2015, version 2.
        Eur Urol. 2016; 69: 16-40
        • Hegde J.V.
        • Mulkern R.V.
        • Panych L.P.
        • et al.
        Multiparametric MRI of prostate cancer: an update on state-of-the-art techniques and their performance in detecting and localizing prostate cancer.
        J Magn Reson Imaging. 2013; 37: 1035-1054
        • Turkbey B.
        • Mani H.
        • Shah V.
        • et al.
        Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds.
        J Urol. 2011; 186: 1818-1824
        • Sonn G.A.
        • Chang E.
        • Natarajan S.
        • et al.
        Value of targeted prostate biopsy using magnetic resonance–ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen.
        Eur Urol. 2014; 65: 809-815
        • Vourganti S.
        • Rastinehad A.
        • Yerram N.K.
        • et al.
        Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies.
        J Urol. 2012; 188: 2152-2157
        • Itatani R.
        • Namimoto T.
        • Atsuji S.
        • et al.
        Negative predictive value of multiparametric MRI for prostate cancer detection: outcome of 5-year follow-up in men with negative findings on initial MRI studies.
        Eur J Radiol. 2014; 83: 1740-1745
        • Pokorny M.R.
        • de Rooij M.
        • Duncan E.
        • et al.
        Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus Magnetic Resonance (MR) imaging with subsequent MR-guided biopsy in men without previous prostate biopsies.
        Eur Urol. 2014; 66: 22-29
        • Filson C.
        • Margolis D.
        • Huang J.
        • et al.
        MP60-11 should a normal multiparametric MRI preclude prostate biopsy?.
        J Urol. 2015; 193: e742
        • Wysock J.S.
        • Mendhiratta N.
        • Zattoni F.
        • et al.
        Predictive value of negative 3T multiparametric magnetic resonance imaging of the prostate on 12-core biopsy results.
        BJU Int. 2016; 118: 515-520
        • Ankerst D.P.
        • Hoefler J.
        • Bock S.
        • et al.
        Prostate Cancer Prevention Trial Risk Calculator 2.0 for the prediction of low- versus high-grade prostate cancer.
        Urology. 2014; 83: 1362-1368
        • Turkbey B.
        • Merino M.J.
        • Gallardo E.C.
        • et al.
        Comparison of endorectal coil and non-endorectal coil T2W and DW MRI at 3T for localizing prostate cancer: correlation with whole-mount histopathology.
        J Magn Reson Imaging. 2014; 39: 1443-1448
        • Barentsz J.O.
        • Richenberg J.
        • Clements R.
        • et al.
        ESUR prostate MR guidelines 2012.
        Eur Radiol. 2012; 22: 746-757
        • Polanec S.
        • Helbich T.H.
        • Bickel H.
        • et al.
        Head-to-head comparison of PI-RADS v2 and PI-RADS v1.
        Eur J Radiol. 2016; 85: 1125-1131
        • Weaver J.K.
        • Kim E.H.
        • Vetter J.M.
        • Fowler K.J.
        • Siegel C.L.
        • Andriole G.L.
        Presence of magnetic resonance imaging suspicious lesion predicts Gleason 7 or greater prostate cancer in biopsy-naive patients.
        Urology. 2016; 88: 119-124
        • Yerram N.K.
        • Volkin D.
        • Turkbey B.
        • et al.
        Low suspicion lesions on multiparametric magnetic resonance imaging predict for the absence of high-risk prostate cancer.
        BJU Int. 2012; 110: E783-E788
        • Catalona W.J.
        • Smith D.S.
        • Ratliff T.L.
        • et al.
        Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.
        N Engl J Med. 1991; 324: 1156-1161
        • Partin A.W.
        • Yoo J.
        • Carter H.B.
        • et al.
        The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer.
        J Urol. 1993; 150: 110-114
        • Schimmöller L.
        • Quentin M.
        • Arsov C.
        • et al.
        Inter-reader agreement of the ESUR score for prostate MRI using in-bore MRI-guided biopsies as the reference standard.
        Eur Radiol. 2013; 23: 3185-3190
        • Rosenkrantz A.B.
        • Lim R.P.
        • Haghighi M.
        • Somberg M.B.
        • Babb J.S.
        • Taneja S.S.
        Comparison of interreader reproducibility of the prostate imaging reporting and data system and Likert scales for evaluation of multiparametric prostate MRI.
        AJR Am J Roentgenol. 2013; 201: W612-W618
        • Garcia-Reyes K.
        • Passoni N.M.
        • Palmeri M.L.
        • et al.
        Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis.
        Abdom Imaging. 2014; 40: 134-142
        • Serrao E.M.
        • Barrett T.
        • Wadhwa K.
        • et al.
        Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy.
        Can Urol Assoc J. 2015; 9: E853-E858
        • Serrao E.
        • Wadhwa K.
        • Frey J.
        • et al.
        1060 true false negative MRI scans in prostate cancer screening: experience from a tertiary referral unit.
        Eur Urol Suppl. 2014; 13 (e1060-e1060a)
        • Schmid H.-P.
        • McNeal J.E.
        • Stamey T.A.
        Observations on the doubling time of prostate cancer. The use of serial prostate-specific antigen in patients with untreated disease as a measure of increasing cancer volume.
        Cancer. 1993; 71: 2031-2040<2031::AID-CNCR2820710618>3.0.CO;2-Q
        • Kk H.
        • Je M.
        • Mk T.
        • Ta S.
        Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate.
        J Urol. 1989; 142 (discussion 74-75): 71-74
        • Djavan B.
        • Zlotta A.
        • Remzi M.
        • et al.
        Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men.
        J Urol. 2000; 163: 1144-1149
        • Cohen M.S.
        • Hanley R.S.
        • Kurteva T.
        • et al.
        Comparing the Gleason prostate biopsy and Gleason prostatectomy grading system: the Lahey Clinic Medical Center experience and an international meta-analysis.
        Eur Urol. 2008; 54: 371-381
        • Thompson J.E.
        • Moses D.
        • Shnier R.
        • et al.
        Multiparametric magnetic resonance imaging guided diagnostic biopsy detects significant prostate cancer and could reduce unnecessary biopsies and over detection: a prospective study.
        J Urol. 2014; 192: 67-74
        • El-Shater Bosaily A.
        • Parker C.
        • Brown L.C.
        • et al.
        PROMIS—Prostate MR Imaging Study: a paired validating cohort study evaluating the role of multi-parametric MRI in men with clinical suspicion of prostate cancer.
        Contemp Clin Trials. 2015; 42: 26-40