H K Sokhi1, A R Padhani2, S Patel3, A Pope4. 1. Department of Radiology, Hillingdon and Mount Vernon Hospitals, The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge UB83NN, UK; Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, HA62RN, UK. Electronic address: hsokhi@nhs.net. 2. Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, HA62RN, UK. 3. Department of Radiology, Hillingdon and Mount Vernon Hospitals, The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge UB83NN, UK. 4. Department of Urology, Hillingdon and Mount Vernon Hospitals, The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge UB83NN, UK.
Abstract
AIM: To document cancer yields of magnetic resonance imaging (MRI)-directed biopsies in men with suspected prostate cancer referred to secondary care. MATERIALS AND METHODS: Men with suspected cancer undergoing multiparametric prostate MRI as the first-line investigation were included in the present study. Systematic transrectal prostate biopsies with/without cognitive targeted biopsies were performed. Diagnostic yields of International Society of Urological Pathology (ISUP) ≥2 cancers by the Prostate Imaging Reporting and Data System (PI-RADS) category were recorded. Impacts of prostate-specific antigen (PSA) density on biopsy results and yields of non-targeted biopsies in MRI non-suspicious prostate sextants assessed. RESULTS: Of 262 men (90.5% biopsy naive), 86 (33%) MRI examinations were negative (PI-RADS 1-2) and 176 (67%) positive (PI-RADS 3: 8%; PI-RADS 4: 21%; PI-RADS 5: 38%). Two hundred and thirteen of 262 patients underwent a biopsy. ISUP ≥2 cancer detection rates were 8% (5/61) for PI-RADS 1-2, 18% (3/17) for PI-RADS 3, 49% (22/45) for PI-RADS 4, and 80% (72/90) for PI-RADS 5. Proportions of ISUP ≥2 increased with higher PSA densities in positive patients (%ISUP ≥2 for PSA density groups <0.12, 0.12 to <0.15 and ≥ 0.15 was 0%, 0%, 25% for PI-RADS 3, 21%, 33%, 68% for PI-RADS 4 and 40%, 83%, 89% for PI-RADS 5 respectively). ISUP ≥2 cancers were twice as likely in tumour adjacent sextants (52% versus 24%), without upgrading of gland level histology from insignificant to clinically significant prostate cancer by the sampling of normal-appearing tumour non-adjacent sextants. CONCLUSIONS: One third of men can avoid biopsy after negative MRI. Cancer detection rates increase with PSA density values within positive MRI suspicion categories. Sampling normal-appearing tumour non-adjacent sextants may be unnecessary for whole-gland therapy. Crown
AIM: To document cancer yields of magnetic resonance imaging (MRI)-directed biopsies in men with suspected prostate cancer referred to secondary care. MATERIALS AND METHODS:Men with suspected cancer undergoing multiparametric prostate MRI as the first-line investigation were included in the present study. Systematic transrectal prostate biopsies with/without cognitive targeted biopsies were performed. Diagnostic yields of International Society of Urological Pathology (ISUP) ≥2 cancers by the Prostate Imaging Reporting and Data System (PI-RADS) category were recorded. Impacts of prostate-specific antigen (PSA) density on biopsy results and yields of non-targeted biopsies in MRI non-suspicious prostate sextants assessed. RESULTS: Of 262 men (90.5% biopsy naive), 86 (33%) MRI examinations were negative (PI-RADS 1-2) and 176 (67%) positive (PI-RADS 3: 8%; PI-RADS 4: 21%; PI-RADS 5: 38%). Two hundred and thirteen of 262 patients underwent a biopsy. ISUP ≥2 cancer detection rates were 8% (5/61) for PI-RADS 1-2, 18% (3/17) for PI-RADS 3, 49% (22/45) for PI-RADS 4, and 80% (72/90) for PI-RADS 5. Proportions of ISUP ≥2 increased with higher PSA densities in positive patients (%ISUP ≥2 for PSA density groups <0.12, 0.12 to <0.15 and ≥ 0.15 was 0%, 0%, 25% for PI-RADS 3, 21%, 33%, 68% for PI-RADS 4 and 40%, 83%, 89% for PI-RADS 5 respectively). ISUP ≥2 cancers were twice as likely in tumour adjacent sextants (52% versus 24%), without upgrading of gland level histology from insignificant to clinically significant prostate cancer by the sampling of normal-appearing tumour non-adjacent sextants. CONCLUSIONS: One third of men can avoid biopsy after negative MRI. Cancer detection rates increase with PSA density values within positive MRI suspicion categories. Sampling normal-appearing tumour non-adjacent sextants may be unnecessary for whole-gland therapy. Crown
Authors: Alberto Artiles Medina; Rafael Rodríguez-Patrón Rodríguez; Mercedes Ruiz Hernández; Marina Mata Alcaraz; Silvia García Barreras; Guillermo Fernández Conejo; Agustín Fraile Poblador; Enrique Sanz Mayayo; Francisco Javier Burgos Revilla Journal: Res Rep Urol Date: 2021-09-27
Authors: Jeroen S Reijnen; Jon B Marthinsen; Alf O Tysland; Christoph Müller; Irina Schönhardt; Erlend Andersen; Therese Seierstad; Knut H Hole Journal: Abdom Radiol (NY) Date: 2021-08-20