Multi-Parametric Magnetic Resonance Imaging to Rule-In and Rule-Out Clinically Important Prostate Cancer in Men at Risk: A Cohort Study

OBJECTIVES: Overdiagnosis is arguably the greatest challenge in the management of men with prostate cancer. Multi-parametric (mp)-MRI prior to prostate biopsy may have a role in ruling-in and ruling-out clinically significant disease. PATIENTS AND METHODS: 114 consecutive men at risk of prostate cancer with previous biopsy underwent mp-MRI prior to transrectal ultrasound (TRUS)-guided biopsies. Standard systematic biopsies were carried out with targeting to suspicious areas. RESULTS: 59.6% had cancer detected by TRUS-guided biopsy. Mean age was 63.6 years (SD 9.0). If men had not been biopsied because of a negative mp-MRI, 21% (24/114) with no cancer and 5% (6/114) with clinically insignificant cancer could have avoided a biopsy. However, 4% (4/114) would have been advised to defer a biopsy that demonstrated the presence of clinically significant cancer. CONCLUSION: mp-MRI may have a role in ruling-in and ruling-out clinically significant prostate cancer in men at risk prior to biopsy.