Key points are not available for this paper at this time.
Upto 40% of patients with suspected PCa have a negative prebiopsy MRI (nMRI) and upto 15% of them may have clinically significant PCa (csPCa). The ability to predict presence of csPCa despite nMRI may help avoid unnecessary biopsies. We aimed to determine the negative predictive value (NPV) of mpMRI, the influence of MRI reporting patterns in clinical practice and the factors that might predict csPCa among men with a nMRI. In an IRB approved, ambispective study men who underwent prostate biopsy from 2016 to 2023, and had a prebiopsy MRI, were included to determine the presence of csPCa. The reporting patterns of institutional and non-institutional MRI were evaluated and age, digital rectal examination (DRE) findings, prostate specific antigen (PSA), PSA density (PSAD) and MRI reporting were evaluated for their ability to predict csPCa in men with nMRI. 1660 patients who underwent prostate biopsy were assessed for eligibility and 685 patients were enrolled in the study. The median age, PSA and PSAD were 60 years, 11.63 ng/ml and 0.23 ng/ml/cm3 respectively. 62 (9%) men had a nMRI among which csPCa, non-csPCa, and negative biopsy were found in 34%, 5%, and 61% men respectively. 61% had an institutional MRI while 39% had a non-institutional MRI. The sensitivity and NPV of any MRI for csPCa was 93% and 66% respectively which improved to 96% and 81% for institutional MRI. Univariate and multivariate analyses showed abnormal DRE and PSAD ≥ 0.25 ng/ml/cc as predictive factors for csPCa in men with nMRI. 34% men with negative MRI were found to harbor csPCa on prostate biopsy. The NPV of institutional MRI was higher than for non-institutional MRI. Men with an abnormal DRE or PSAD ≥ 0.25 ng/ml/cc had higher incidence of csPCa despite an nMRI.
Arulraj et al. (Fri,) studied this question.