Julie Y An1, Abhinav Sidana2,3, Sarah A Holzman4, Joseph A Baiocco2, Sherif Mehralivand5, Peter L Choyke5, Bradford J Wood6, Baris Turkbey5, Peter A Pinto2. 1. Center for Interventional Oncology, NIH Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Bethesda, MD, 20814, USA. julieyajiean@gmail.com. 2. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 3. Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 4. Department of Urology, Georgetown University School of Medicine, Washington, DC, USA. 5. Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. 6. Center for Interventional Oncology, NIH Clinical Center, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Bethesda, MD, 20814, USA.
Abstract
PURPOSE: To evaluate the negative predictive value (NPV) of a negative prostate multi-parametric magnetic resonance imaging (mpMRI) in ruling out clinically significant prostate upon 12-core systematic biopsy. METHODS: We retrospectively reviewed 114 men evaluated at our institution who underwent systematic 12-core biopsy within 1 year of a negative prostate mpMRI. Clinicopathologic features were evaluated and NPV was calculated for detection of clinically significant (Gleason ≥ 7) cancer. Regression analysis was performed to identify clinical predictors of biopsy outcome. RESULTS: Overall, 88 (77.2%) patients in our cohort had no cancer detected upon biopsy. The highest pathologic grade was Gleason 6 (3 + 3) in 22 (19.3%) patients, and Gleason ≥ 7 in 4 (3.6%) patients. NPV for detecting Gleason ≥ 7 cancer was 96.5% (95% CI 93.1-99.9%) in the entire negative MRI cohort, 100% in those who were prostate biopsy naïve (n = 20), 100% in those with a prior negative biopsy (n = 53), and 90% in those who have had a previous positive biopsy and on active surveillance (n = 41). Regression analysis identified no predictors of significant cancer in our cohort. CONCLUSION: In our cohort of men with no lesions detected on prostate mpMRI, we found very low rates of clinically significant cancer on systematic 12-core biopsy. In the few patients who diagnosed with prostate cancer, the majority had low-risk disease and could remain on active surveillance. Although validation studies and greater sample size is needed before clinical recommendations can be made, our data suggest patients with negative mpMRI evaluated by experienced radiologists may avoid unnecessary prostate biopsy and potential overtreatment.
PURPOSE: To evaluate the negative predictive value (NPV) of a negative prostate multi-parametric magnetic resonance imaging (mpMRI) in ruling out clinically significant prostate upon 12-core systematic biopsy. METHODS: We retrospectively reviewed 114 men evaluated at our institution who underwent systematic 12-core biopsy within 1 year of a negative prostate mpMRI. Clinicopathologic features were evaluated and NPV was calculated for detection of clinically significant (Gleason ≥ 7) cancer. Regression analysis was performed to identify clinical predictors of biopsy outcome. RESULTS: Overall, 88 (77.2%) patients in our cohort had no cancer detected upon biopsy. The highest pathologic grade was Gleason 6 (3 + 3) in 22 (19.3%) patients, and Gleason ≥ 7 in 4 (3.6%) patients. NPV for detecting Gleason ≥ 7 cancer was 96.5% (95% CI 93.1-99.9%) in the entire negative MRI cohort, 100% in those who were prostate biopsy naïve (n = 20), 100% in those with a prior negative biopsy (n = 53), and 90% in those who have had a previous positive biopsy and on active surveillance (n = 41). Regression analysis identified no predictors of significant cancer in our cohort. CONCLUSION: In our cohort of men with no lesions detected on prostate mpMRI, we found very low rates of clinically significant cancer on systematic 12-core biopsy. In the few patients who diagnosed with prostate cancer, the majority had low-risk disease and could remain on active surveillance. Although validation studies and greater sample size is needed before clinical recommendations can be made, our data suggest patients with negative mpMRI evaluated by experienced radiologists may avoid unnecessary prostate biopsy and potential overtreatment.
Entities:
Keywords:
Active surveillance; Biopsy; Imaging; Multi-parametric MRI; Oncology; PI-RADS v2; Prostate cancer
Authors: M Minhaj Siddiqui; Soroush Rais-Bahrami; Baris Turkbey; Arvin K George; Jason Rothwax; Nabeel Shakir; Chinonyerem Okoro; Dima Raskolnikov; Howard L Parnes; W Marston Linehan; Maria J Merino; Richard M Simon; Peter L Choyke; Bradford J Wood; Peter A Pinto Journal: JAMA Date: 2015-01-27 Impact factor: 56.272
Authors: R Itatani; T Namimoto; S Atsuji; K Katahira; S Morishita; K Kitani; Y Hamada; M Kitaoka; T Nakaura; Y Yamashita Journal: Eur J Radiol Date: 2014-07-03 Impact factor: 3.528
Authors: M Minhaj Siddiqui; Arvin K George; Rachel Rubin; Soroush Rais-Bahrami; Howard L Parnes; Maria J Merino; Richard M Simon; Baris Turkbey; Peter L Choyke; Bradford J Wood; Peter A Pinto Journal: J Natl Cancer Inst Date: 2016-04-29 Impact factor: 13.506
Authors: James S Wysock; Neil Mendhiratta; Fabio Zattoni; Xiaosong Meng; Marc Bjurlin; William C Huang; Herbert Lepor; Andrew B Rosenkrantz; Samir S Taneja Journal: BJU Int Date: 2016-02-25 Impact factor: 5.588
Authors: Soroush Rais-Bahrami; M Minhaj Siddiqui; Baris Turkbey; Lambros Stamatakis; Jennifer Logan; Anthony N Hoang; Annerleim Walton-Diaz; Srinivas Vourganti; Hong Truong; Jochen Kruecker; Maria J Merino; Bradford J Wood; Peter L Choyke; Peter A Pinto Journal: J Urol Date: 2013-05-29 Impact factor: 7.450
Authors: Hashim U Ahmed; Ahmed El-Shater Bosaily; Louise C Brown; Rhian Gabe; Richard Kaplan; Mahesh K Parmar; Yolanda Collaco-Moraes; Katie Ward; Richard G Hindley; Alex Freeman; Alex P Kirkham; Robert Oldroyd; Chris Parker; Mark Emberton Journal: Lancet Date: 2017-01-20 Impact factor: 79.321
Authors: Sena Tuncer; Sherif Mehralivand; Stephanie A Harmon; Thomas Sanford; G Thomas Brown; Lindsay S Rowe; Maria J Merino; Bradford J Wood; Peter A Pinto; Peter L Choyke; Baris Turkbey Journal: Abdom Radiol (NY) Date: 2020-10
Authors: Sonia Gaur; Esther Mena; Stephanie A Harmon; Maria L Lindenberg; Stephen Adler; Anita T Ton; Joanna H Shih; Sherif Mehralivand; Maria J Merino; Bradford J Wood; Peter A Pinto; Ronnie C Mease; Martin G Pomper; Peter L Choyke; Baris Turkbey Journal: AJR Am J Roentgenol Date: 2020-07-08 Impact factor: 3.959
Authors: Abhinav Sidana; Matthew J Watson; Arvin K George; Ardeshir R Rastinehad; Srinivas Vourganti; Soroush Rais-Bahrami; Akhil Muthigi; Mahir Maruf; Jennifer B Gordetsky; Jeffrey W Nix; Maria J Merino; Baris Turkbey; Peter L Choyke; Bradford J Wood; Peter A Pinto Journal: Urol Oncol Date: 2018-05-10 Impact factor: 3.498
Authors: Piotr Zapała; Bartosz Dybowski; Ewa Bres-Niewada; Tomasz Lorenc; Agnieszka Powała; Zbigniew Lewandowski; Marek Gołębiowski; Piotr Radziszewski Journal: Int Urol Nephrol Date: 2019-06-10 Impact factor: 2.370
Authors: Armonde A Baghdanian; Yoon-Jin Kim; Arthur H Baghdanian; Hao N Nguyen; Katsuto Shinohara; Antonio C Westphalen Journal: Radiol Bras Date: 2019 Sep-Oct