Objective
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.
Results
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).
Conclusion
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.
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Article info
Publication history
Published online: November 11, 2016
Accepted:
October 10,
2016
Received:
July 22,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
