Filippo Russo1, Simone Mazzetti2, Daniele Regge3, Ilaria Ambrosini1, Valentina Giannini3, Matteo Manfredi4, Stefano De Luca4, Enrico Bollito5, Francesco Porpiglia4. 1. Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy. 2. Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy. Electronic address: simone.mazzetti@unito.it. 3. Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy. 4. Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. 5. Department of Pathology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
Abstract
BACKGROUND: Urological guidelines recommend multiparametric magnetic resonance imaging (mpMRI) in men with a suspicion of prostate cancer (PCa). The resulting increase in MRI demand might place health care systems under substantial stress. OBJECTIVE: To determine whether single-plane biparametric MRI (fast MRI) workup could represent an alternative to mpMRI in the detection of clinically significant (cs) PCa. DESIGN, SETTING, AND PARTICIPANTS: Between April 2018 and February 2020, 311 biopsy-naïve men aged ≤75 yr with PSA ≤15 ng/ml and negative digital rectal examination were randomly assigned to 1.5-T fast MRI (n = 213) or mpMRI (n = 98). INTERVENTION: All MRI examinations were classified according to Prostate Imaging-Reporting and Data System (PI-RADS) version 2. Men scored PI-RADS 1-2 underwent 12-core standard biopsy (SBx) and those with PI-RADS 4-5 on fast MRI or PI-RADS 3-5 on mpMRI underwent targeted biopsy in combination with SBx. Equivocal cases on fast MRI (PI-RADS 3) underwent mpMRI and then biopsy according to the findings. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was to compare the detection rate of csPCa in both study arms, setting a 10% difference for noninferiority. The secondary outcome was to assess the role of prostate-specific antigen density (PSAD) in ruling out men who could avoid biopsy among those with equivocal findings on fast MRI. RESULTS AND LIMITATIONS: The overall MRI detection rate for csPCa was 23.5% (50/213; 95% confidence interval [CI] 18.0-29.8%) with fast MRI and 32.7% (32/98; 95% CI 23.6-42.9%) with mpMRI (difference 9.2%; p = 0.09). The reproducibility of the study could have been affected by its single-center nature. CONCLUSIONS: Fast MRI followed by mpMRI in equivocal cases is not inferior to mpMRI in the detection of csPCa among biopsy-naïve men aged ≤75 yr with PSA ≤15 ng/ml and negative digital rectal examination. These findings could pave the way to broader use of MRI for PCa diagnosis. PATIENT SUMMARY: A faster MRI (magnetic resonance imaging) protocol with no contrast agent and fewer scan sequences for examination of the prostate is not inferior to the typical MRI approach in the detection of clinically significant prostate cancer. If our findings are confirmed in other studies, fast MRI could represent a time-saving and less invasive examination for men with suspicion of prostate cancer. This trial is registered at ClinicalTrials.gov as NCT03693703.
BACKGROUND: Urological guidelines recommend multiparametric magnetic resonance imaging (mpMRI) in men with a suspicion of prostate cancer (PCa). The resulting increase in MRI demand might place health care systems under substantial stress. OBJECTIVE: To determine whether single-plane biparametric MRI (fast MRI) workup could represent an alternative to mpMRI in the detection of clinically significant (cs) PCa. DESIGN, SETTING, AND PARTICIPANTS: Between April 2018 and February 2020, 311 biopsy-naïve men aged ≤75 yr with PSA ≤15 ng/ml and negative digital rectal examination were randomly assigned to 1.5-T fast MRI (n = 213) or mpMRI (n = 98). INTERVENTION: All MRI examinations were classified according to Prostate Imaging-Reporting and Data System (PI-RADS) version 2. Men scored PI-RADS 1-2 underwent 12-core standard biopsy (SBx) and those with PI-RADS 4-5 on fast MRI or PI-RADS 3-5 on mpMRI underwent targeted biopsy in combination with SBx. Equivocal cases on fast MRI (PI-RADS 3) underwent mpMRI and then biopsy according to the findings. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was to compare the detection rate of csPCa in both study arms, setting a 10% difference for noninferiority. The secondary outcome was to assess the role of prostate-specific antigen density (PSAD) in ruling out men who could avoid biopsy among those with equivocal findings on fast MRI. RESULTS AND LIMITATIONS: The overall MRI detection rate for csPCa was 23.5% (50/213; 95% confidence interval [CI] 18.0-29.8%) with fast MRI and 32.7% (32/98; 95% CI 23.6-42.9%) with mpMRI (difference 9.2%; p = 0.09). The reproducibility of the study could have been affected by its single-center nature. CONCLUSIONS: Fast MRI followed by mpMRI in equivocal cases is not inferior to mpMRI in the detection of csPCa among biopsy-naïve men aged ≤75 yr with PSA ≤15 ng/ml and negative digital rectal examination. These findings could pave the way to broader use of MRI for PCa diagnosis. PATIENT SUMMARY: A faster MRI (magnetic resonance imaging) protocol with no contrast agent and fewer scan sequences for examination of the prostate is not inferior to the typical MRI approach in the detection of clinically significant prostate cancer. If our findings are confirmed in other studies, fast MRI could represent a time-saving and less invasive examination for men with suspicion of prostate cancer. This trial is registered at ClinicalTrials.gov as NCT03693703.
Authors: Ugo Giovanni Falagario; Oscar Selvaggio; Francesca Sanguedolce; Paola Milillo; Maria Chiara Sighinolfi; Salvatore Mariano Bruno; Marco Recchia; Carlo Bettocchi; Gian Maria Busetto; Luca Macarini; Bernardo Rocco; Luigi Cormio; Giuseppe Carrieri Journal: Diagnostics (Basel) Date: 2022-01-21