The diagnostic accuracy of multiparametric MRI for significant prostate cancer when compared to transperineal biopsy.

Abstract

INTRODUCTION: The aim of this study was to determine the accuracy of multiparametric magnetic resonance imaging (mpMRI) of the prostate in diagnosis of significant prostate cancer (Grade group 2 and above) in patients with no history of prostate cancer, by directly comparing it to the results of transperineal biopsy of the prostate (TPB) when taking template cores as well as targeted cores where mpMRI is positive. MATERIALS & METHODS: A total of 437 patients who had no previous history of prostate cancer had a mpMRI between the study period of June 2013 and January 2016, of these 243 patients had a subsequent TPB. These results were analyzed from a custom made REDCap electronic data capture program. The correlation between Prostate Imaging Reporting and Data System (PIRADS) score and TPB histology was calculated. RESULTS: mpMRI reported that 160 patients as possibly, likely or highly likely as having clinically significant prostate cancer (PIRADS 3,4,5) and 83 patients as not having suspicious features on their imaging (PIRADS 1,2). TPB diagnosed 132 patients with clinically significant cancer and 111 patients showed no evidence of significant prostate cancer. mpMRI has a sensitivity of 83.3% for significant prostate cancer; however, its specificity is lower at 55%. CONCLUSIONS: mpMRI is a valuable diagnostic tool for prostate cancer in conjunction with prostate-specific antigen density, digital rectal exam, and TPB. Its high sensitivity allows judicious use of TPB among patients. mpMRI should be used prior to TPB in prostate cancer diagnosis as suspicious lesions can be targeted.