Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal Examination
<b>Objectives</b>: Few studies have examined the role of prostate MRI in patients with suspicious digital rectal examination (DRE) and/or PSA > 10 ng/mL. In a cohort of non-screened patients with suspicious DRE, we investigated the rate of avoidable prostate biopsies and potentially m...
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2024-04-01
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| author | Vincenzo Ficarra Alessandro Buttitta Marta Rossanese Angela Alibrandi Giuseppina Anastasi Alfredo Blandino Antonio Ieni Maurizio Martini Gianluca Giannarini |
| author_facet | Vincenzo Ficarra Alessandro Buttitta Marta Rossanese Angela Alibrandi Giuseppina Anastasi Alfredo Blandino Antonio Ieni Maurizio Martini Gianluca Giannarini |
| author_sort | Vincenzo Ficarra |
| collection | DOAJ |
| description | <b>Objectives</b>: Few studies have examined the role of prostate MRI in patients with suspicious digital rectal examination (DRE) and/or PSA > 10 ng/mL. In a cohort of non-screened patients with suspicious DRE, we investigated the rate of avoidable prostate biopsies and potentially missed clinically significant prostate cancer (csPCa) with negative MRI, and the concordance between targeted biopsy (TBx) and systematic biopsy (SBx) in detecting csPCa with positive MRI. <b>Methods</b>: We retrospectively examined 199 biopsy-naïve patients with suspicious DRE who underwent prostate MRI before transperineal biopsy. Prostate Imaging—Reporting and Data System (PI-RADS) v2.1 ≥ 3 category of the index lesion defined a positive MRI. Combined TBx/SBx and SBx alone were performed for positive and negative MRI, respectively. An International Society of Urogenital Pathology Grade Group ≥ 2 defined csPCa. We calculated the csPCa detection rate of TBx, SBx, and combined TBx/SBx. The Cohen kappa statistic was used to measure the concordance between TBx and SBx. <b>Results</b>: Ninety-one (45.7%) csPCa cases were detected. MRI was positive in 153 (76.9%) patients. In the 46 patients with negative MRI, SBx detected 5 (10.9%) csPCa cases. Prostate biopsy could, thus, be avoided in 41/199 (20.6%) patients at the cost of missing 5/91 (5.5%) csPCa cases. The concordance between TBx and SBx in detecting csPCa with positive mpMRI was substantial (k = 0.70). Specifically, 6/86 (6.9%) csPCa cases were detected with TBx, and 17/86 (19.7%) with SBx alone. Concordance was almost perfect (k = 0.82) in patients with PSA > 10 ng/mL. Only 4/38 (10.5%) csPCa cases were missed by TBx, and only 1 (2.6%) csPCa case was identified by TBx alone. <b>Conclusions</b>: MRI in patients with suspicious DRE could avoid roughly 21% of unnecessary biopsies at the cost of missing approximately 6% of csPCa cases. Moreover, MRI and TBx complemented SBx in detecting csPCa in the subgroup with PSA > 10 ng/mL. |
| format | Article |
| id | doaj-art-e2516ba7a72d48c788aaf2a1d7caf03c |
| institution | DOAJ |
| issn | 2563-6499 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Société Internationale d’Urologie Journal |
| spelling | doaj-art-e2516ba7a72d48c788aaf2a1d7caf03c2025-08-20T02:54:37ZengMDPI AGSociété Internationale d’Urologie Journal2563-64992024-04-015212213210.3390/siuj5020021Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal ExaminationVincenzo Ficarra0Alessandro Buttitta1Marta Rossanese2Angela Alibrandi3Giuseppina Anastasi4Alfredo Blandino5Antonio Ieni6Maurizio Martini7Gianluca Giannarini8Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, ItalyGaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, 98125 Messina, ItalyGaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, 98125 Messina, ItalyDepartment of Economics, Division of Statistical and Mathematical Sciences, University of Messina, 98125 Messina, ItalyGaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, 98125 Messina, ItalyDepartment of Biomedical Sciences and Morphological and Functional Imaging, Diagnostic Imaging Section, University of Messina, 98125 Messina, ItalyGaetano Barresi Department of Human and Paediatric Pathology, Pathology Section, University of Messina, 98125 Messina, ItalyGaetano Barresi Department of Human and Paediatric Pathology, Pathology Section, University of Messina, 98125 Messina, ItalyUrology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy<b>Objectives</b>: Few studies have examined the role of prostate MRI in patients with suspicious digital rectal examination (DRE) and/or PSA > 10 ng/mL. In a cohort of non-screened patients with suspicious DRE, we investigated the rate of avoidable prostate biopsies and potentially missed clinically significant prostate cancer (csPCa) with negative MRI, and the concordance between targeted biopsy (TBx) and systematic biopsy (SBx) in detecting csPCa with positive MRI. <b>Methods</b>: We retrospectively examined 199 biopsy-naïve patients with suspicious DRE who underwent prostate MRI before transperineal biopsy. Prostate Imaging—Reporting and Data System (PI-RADS) v2.1 ≥ 3 category of the index lesion defined a positive MRI. Combined TBx/SBx and SBx alone were performed for positive and negative MRI, respectively. An International Society of Urogenital Pathology Grade Group ≥ 2 defined csPCa. We calculated the csPCa detection rate of TBx, SBx, and combined TBx/SBx. The Cohen kappa statistic was used to measure the concordance between TBx and SBx. <b>Results</b>: Ninety-one (45.7%) csPCa cases were detected. MRI was positive in 153 (76.9%) patients. In the 46 patients with negative MRI, SBx detected 5 (10.9%) csPCa cases. Prostate biopsy could, thus, be avoided in 41/199 (20.6%) patients at the cost of missing 5/91 (5.5%) csPCa cases. The concordance between TBx and SBx in detecting csPCa with positive mpMRI was substantial (k = 0.70). Specifically, 6/86 (6.9%) csPCa cases were detected with TBx, and 17/86 (19.7%) with SBx alone. Concordance was almost perfect (k = 0.82) in patients with PSA > 10 ng/mL. Only 4/38 (10.5%) csPCa cases were missed by TBx, and only 1 (2.6%) csPCa case was identified by TBx alone. <b>Conclusions</b>: MRI in patients with suspicious DRE could avoid roughly 21% of unnecessary biopsies at the cost of missing approximately 6% of csPCa cases. Moreover, MRI and TBx complemented SBx in detecting csPCa in the subgroup with PSA > 10 ng/mL.https://www.mdpi.com/2563-6499/5/2/21prostate cancermultiparametric MRIprostate biopsydigital rectal examination |
| spellingShingle | Vincenzo Ficarra Alessandro Buttitta Marta Rossanese Angela Alibrandi Giuseppina Anastasi Alfredo Blandino Antonio Ieni Maurizio Martini Gianluca Giannarini Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal Examination Société Internationale d’Urologie Journal prostate cancer multiparametric MRI prostate biopsy digital rectal examination |
| title | Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal Examination |
| title_full | Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal Examination |
| title_fullStr | Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal Examination |
| title_full_unstemmed | Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal Examination |
| title_short | Role of Multiparametric Magnetic Resonance Imaging and Targeted Biopsy in the Detection of Clinically Significant Prostate Cancer in Patients with Suspicious Digital Rectal Examination |
| title_sort | role of multiparametric magnetic resonance imaging and targeted biopsy in the detection of clinically significant prostate cancer in patients with suspicious digital rectal examination |
| topic | prostate cancer multiparametric MRI prostate biopsy digital rectal examination |
| url | https://www.mdpi.com/2563-6499/5/2/21 |
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