The Additive Value of MRI Targeted Biopsy on Prostate Cancer Detection in Patients with Serum Prostate-specific Antigen 20-100 ng/mL and Normal Digital Rectal Examination

Abstract

Objectives: The study investigates whether multiparametric magnetic resonance imaging (mpMRI) targeted biopsy (MRI-TB) is necessary in the setting of prostate-specific antigen (PSA) 20-100 ng/mL and normal digital rectal examination (DRE). Materials and Methods: Patients undergoing MRI-TB and concomitant systematic biopsies (SB) with a PSA 20-100 ng/mL and normal DRE were retrospectively reviewed in Prostate Cancer Database of Turkish Urooncology Association. Pathological data of MRI-TB was compared to the SB data. All patients underwent mpMRI followed by transrectal/transperineal MRI-TB of any Prostate Imaging Reporting and Data System lesion and 12-core SB. The prostate cancer (PCa) and clinically significant PCa (csPCa) (grade group >= 2) detection on MRI-TB, SB and MRI-TB+SB were determined for all patients. A subgroup analysis of combined (MRI-TB+SB) group was also performed to identify performances of MRI-TB alone, SB alone and combination of MRI-TB+SB for the prediction of final pathology at radical prostatectomy (RP). Statistically significance was set at p<0.05. Results: In the study 65 patients were evaluated. Among them, 35 have PCa and 32 of them were csPCa. The detection rate of PCa for MRI-TB+SB, MRI-TB and SB were 53%, 46% and 36%, respectively, and csPCa detection rates were 49%, 41% and 33%, respectively. TB added 31.4% of any grade PCa and 31.25% csPCa detection over SB. csPCa detection rate improved with increased PSA density for TB. Among 15 patients who underwent RP,6 patients were found to have csPCa on final pathology which went undetected or undergraded with SB biopsy initially. Conclusion: MRI-TB based on mpMRI presents a valuable addition to SB in patients with PSA 20-100 ng/mL and normal DRE.