Multiparametric MR of the prostate in patients with previous negative biopsies
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INTRODUCTION
The clinical indications to multiparametric MR of the prostate continue to evolve.We evaluated the utility of multiparametric MR of the prostate in the “grey zone” patient population who had a previous negative prostate biopsy and persistent high tPSA.
METHODS
We evaluated retrospectively the data from a group of patients who underwent to MRI/US cognitive prostate biopsies from May2013 to September 2014.All the patients had a previous negative 12-core prostate biopsy.In all patients, multiparametric prostate MR without endorectal coil was performed using T2-weighted, diffusion-weighted and dynamic contrast-enhanced imaging (T2WI,DWI,DCE-MRI).1.5TMR imaging have been used in all the patients.The radiologist reported the region of interest(ROI)in the final imaging report.The radiologist and the urologist revaluated together the imaging before the biopsy.All patients had 10-core standard biopsy(SB)and 2-core cognitive target biopsy(CB)with transrectal ultrasonography(US)guidance according to the MR results.
RESULTS
Based on increasing tPSA levels,35 patients in our institution were sent for prostate biopsies in the period between 05/2013 and 09/2014 according to the results of the prostate MR.
All the regions of interest were reported according with PIRADS system.A single genitourinary pathologist reviewed pathology.Mean PSA was 7.4 ng/ml, median prostate volume was 48gr, PSA velocity was 1,15(ng/l/yr)with a mean age of 65 years. Patients presented ROI PIRADS<2 in 7(20%)cases, PIRADS3 in 11(31,43%)cases, PIRADS4 in 12(34,29%)cases and PIRADS5 in 5(14,29%)cases.Positivity biopsy rate for prostate cancer PCa was 51,3%(npt.=18), positivity biopsy rate for clinically significant PCa is 40%(npt.=14)and clinically insignificant cancer is 11,4%(npt.=4)after target cognitive biopsy.17 patients(48,5%)underwent to radical prostatectomy.Final pathology reports were pT2b in 2 patients(11.8%),pT2c in 5 patients(29.5%),pT3a in 6 patients(35.2%)and pT3b in 4 patients(23.5%).
CONCLUSION
MR multiparametric prostate biopsy increases the detection rate of prostate cancer diagnosis in previous negative biopsy patient population with tPSA elevated.In particular cognitive fusion biopsy increase the detection rate of clinically significant disease in this group of patients.
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