Negative Multiparametric Magnetic Resonance Imaging of the Prostate Predicts Absence of Clinically Significant Prostate Cancer on 12-Core Template Prostate Biopsy


      To determine the negative predictive value of multiparametric magnetic resonance imaging (mpMRI), we evaluated the frequency of prostate cancer detection by 12-core template mapping biopsy in men whose mpMRI showed no suspicious regions.


      Six hundred seventy patients underwent mpMRI followed by transrectal ultrasound (TRUS)-guided systematic prostate biopsy from December 2012 to June 2016. Of this cohort, 100 patients had a negative mpMRI. mpMRI imaging sequences included T2-weighted and diffusion-weighted imaging, and dynamic contrast enhancement sequences.


      The mean age, prostate-specific antigen, and prostate volume of the 100 men included were 64.3 years, 7.2 ng/mL, and 71 mL, respectively. Overall cancer detection was 27% (27 of 100). Prostate cancer was detected in 26.3% (10 of 38) of patients who were biopsy-naïve, 12.1% (4 of 33) of patients who had a prior negative biopsy, and in 44.8% (13 of 29) of patients previously on active surveillance; Gleason grade ≥7 was detected in 3% of patients overall (3 of 100). The negative predictive value of a negative mpMRI was 73% for all prostate cancer and 97% for Gleason ≥7 prostate cancer.


      There is an approximately 3% chance of detecting clinically significant prostate cancer with systematic TRUS-guided biopsy in patients with no suspicious findings on mpMRI. This information should help guide recommendations to patients about undergoing systematic TRUS-guided biopsy when mpMRI is negative.
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        • Thompson J.E.
        • van Leeuwen P.J.
        • Moses D.
        • et al.
        The diagnostic performance of multiparametric magnetic resonance imaging to detect significant prostate cancer.
        J Urol. 2015; 195: 1428-1435
        • Siddiqui M.M.
        • Rais-Bahrami S.
        • Truong H.
        • et al.
        Magnetic resonance imaging/ultrasound-fusion biopsy significantly upgrades prostate cancer versus systematic 12-core transrectal ultrasound biopsy.
        Eur Urol. 2013; 64: 713
        • Park S.Y.
        • Jung D.C.
        • Oh Y.T.
        • et al.
        Prostate cancer: PI-RADS version 2 helps preoperatively predict clinically significant cancers.
        Radiology. 2016; 280: 108
        • Hoang Dinh A.
        • Melodelima C.
        • Souchon R.
        • et al.
        Quantitative analysis of prostate multiparametric MR images for detection of aggressive prostate cancer in the peripheral zone: a multiple imager study.
        Radiology. 2016; 280: 117
        • Washino S.
        • Okochi T.
        • Saito K.
        • et al.
        Combination of PI-RADS score and PSA density predicts biopsy outcome in biopsy naive patients.
        BJU Int. 2017; 119: 225-233
        • Sonn G.A.
        • Natarajan S.
        • Margolis D.J.
        • et al.
        Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device.
        J Urol. 2013; 189: 86
        • Siddiqui M.M.
        • Rais-Bahrami S.
        • Turkbey B.
        • et al.
        Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer.
        JAMA. 2015; 313: 390
        • Wysock J.S.
        • Mendhiratta N.
        • Zattoni F.
        • et al.
        Predictive value of negative 3T multiparametric prostate MRI on 12 core biopsy results.
        BJU Int. 2016; 118: 515-520
        • Barentsz J.O.
        • Richenberg J.
        • Clements R.
        • et al.
        ESUR prostate MR guidelines 2012.
        Eur Radiol. 2012; 22: 746
        • 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
        • Le J.D.
        • Tan N.
        • Shkolyar E.
        • et al.
        Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology.
        Eur Urol. 2015; 67: 569
        • Portalez D.
        • Mozer P.
        • Cornud F.
        • et al.
        Validation of the European Society of Urogenital Radiology scoring system for prostate cancer diagnosis on multiparametric magnetic resonance imaging in a cohort of repeat biopsy patients.
        Eur Urol. 2012; 62: 986
        • Russo F.
        • Regge D.
        • Armando E.
        • et al.
        Detection of prostate cancer index lesions with multiparametric magnetic resonance imaging (mp-MRI) using whole-mount histological sections as the reference standard.
        BJU Int. 2016; 118: 84
        • Vargas H.A.
        • Hotker A.M.
        • Goldman D.A.
        • et al.
        Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference.
        Eur Radiol. 2016; 26: 1606