2220 Magnetic Resonance Imaging Detects Significant Prostate Cancer and Could Be Used to Reduce Unnecessary Biopsies: Initial Results From a Prospective Trial

You have accessJournal of UrologyProstate Cancer: Detection & Screening (V)1 Apr 20132220 MAGNETIC RESONANCE IMAGING DETECTS SIGNIFICANT PROSTATE CANCER AND COULD BE USED TO REDUCE UNNECESSARY BIOPSIES: INITIAL RESULTS FROM A PROSPECTIVE TRIAL James Thompson, Phillip Stricker, Phillip Brenner, Daniel Moses, Ron Shnier, Warick Delprado, Anne Maree Haynes, and Andrew Hayen James ThompsonJames Thompson Darlinghurst NSW, Australia , Phillip StrickerPhillip Stricker Darlinghurst NSW, Australia , Phillip BrennerPhillip Brenner Darlinghurst NSW, Australia , Daniel MosesDaniel Moses Randwick NSW, Australia , Ron ShnierRon Shnier Randwick, Australia , Warick DelpradoWarick Delprado North Ryde NSW, Australia , Anne Maree HaynesAnne Maree Haynes Darlinghurst NSW, Australia , and Andrew HayenAndrew Hayen Kensington NSW, Australia View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2129AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A major limitation of screening for prostate cancer using PSA and DRE is their poor combined specificity, resulting in a high rate of negative biopsies. The study objective was to assess whether an magnetic resonance imaging (MRI) scan that was negative could reliably exclude cancer and thus enable biopsy to be deferred. METHODS We plan to enrol 300 men in this prospective study. The study was commenced in April 2012. Men planned to undergo biopsy for an abnormal PSA or DRE were enrolled: they underwent multi-parametric MRI (including anatomical, diffusion-weighted and dynamic contrast enhanced imaging) without an endo-rectal coil, with participants allocated in equal numbers to 1.5 or 3 Tesla MRI. Two radiologists experienced in prostate MRI used the standardised Prostate Imaging, Reporting And Data System (PIRADS) to allocate a score of 1 (very unlikely) to 5 (very likely) for their suspicion of significant cancer (cancer with any of: PSA>10; or Gleason > 7; or Gleason= 7 with > 5% grade 4; or clinical stage >T2a). Two urologists then performed a standardised trans-perineal, template-guided biopsy of 14-18 regions with a mean of 31 cores (depending on prostate volume), including manually-directed cores from MRI-suspicious regions. RESULTS 100 men were included in the initial analysis, with a median age of 62.4 years and PSA of 6.9. 26% had an abnormal DRE and 32% had a family history of prostate cancer. 36% were diagnosed with a significant cancer on biopsy. 67% of men had a positive MRI result (PIRADS 3 to 5). On 2x2 square analysis, the sensitivity, negative predictive value, specificity and positive predictive value of a positive MRI for significant cancer was 97%, 97%, 50% and 52%. If biopsy had been deferred in those men with a negative MRI (PIRADS 1-2), 33 out of 100 men would have avoided biopsy and only 1 significant cancer would not have been diagnosed. On logistic regression analysis, the area under the receiver operating curve (AUC) for MRI alone was 0.85 for prediction of significant cancer. The AUC for a multi-variate predictive model using age, PSA, family history and DRE was 0.84; adding MRI to the model improved the AUC to 0.91. CONCLUSIONS Use of MRI in men with abnormal PSA/ DRE planned for prostate biopsy may reduce the number of unnecessary biopsies without reducing the number of significant cancers detected. *Updated data including an updated predictive model, radiologist correlation, and a subset analysis of around 40 men undergoing radical prostatectomy will also be presented. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e910-e911 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information James Thompson Darlinghurst NSW, Australia More articles by this author Phillip Stricker Darlinghurst NSW, Australia More articles by this author Phillip Brenner Darlinghurst NSW, Australia More articles by this author Daniel Moses Randwick NSW, Australia More articles by this author Ron Shnier Randwick, Australia More articles by this author Warick Delprado North Ryde NSW, Australia More articles by this author Anne Maree Haynes Darlinghurst NSW, Australia More articles by this author Andrew Hayen Kensington NSW, Australia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...