The diagnostic outcomes of men with a negative multi-parametric magnetic resonance imaging (mpMRI) for the diagnosis of prostate cancer, in low-risk biopsy naive men

By:

Rhudd, A

Contributor(s):

Publication details: 2017Uniform titles:

Journal of Endourology

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Summary: Introduction & Objective: The routine use of pre-biopsy multiparametric MRI (mpMRI) for the early diagnosis of prostate cancer (CaP) is controversial. A consensus on the optimal management algorithm of a low risk man with a negative mpMRI is unclear. Current guidelines suggest prostate specific antigen (PSA), digital rectal examination (DRE) and shared decisionmaking should be used to determine if a biopsy should be done. mpMRI has the potential to be used as an additional screening tool to select some men to avoid biopsy, potentially lowering the associated harms and over diagnosis. This study evaluated the outcomes of low risk, mpMRI negative men at our institution. Materials and Methods: Between September 2015 and August 2016, 206 men with a PSA <10 ug/L underwent mpMRI for suspected CaP. 22 men were excluded for: previous TURP, previous MRI, prior biopsy or known CaP. 184 men were evaluated for PSA, MRI findings, Prostate Imaging Reporting and Data System (PI-RADS) score, transrectal ultrasound guided (TRUS) biopsy findings and Gleason scores. Results: 57/184 (31%) of mpMRIs done were thought to have no evidence of CaP (PI-RADS <3). 24/57(42%) of men with a negative MRI went on to have a TRUS biopsy. Of those biopsied, 9/24 (37.5%) were positive and 15/24 (62.5%) were negative for CaP. 6/9 (66.7%) positive biopsies were Gleason 3 + 3 (clinically insignificant CaP). 3/24 (12.5%) of men with a negative MRI had clinically significant CaP, as high as Gleason 4 + 5. Conclusions: Less than half of the men at low risk of prostate cancer (PSA <10 ug/L) that have a negative MRI went on to have a biopsy done. 12.5% of men with a negative mpMRI will have clinically significant CaP. These results indicate that until the performance of mpMRI is improved and definitive surveillance protocols are devised TRUS biopsy continues to play a role in men with negative mpMRIs. [Conference abstract]

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NMUH Staff Publications

EMBASE

Introduction &amp; Objective: The routine use of pre-biopsy multiparametric MRI (mpMRI) for the early diagnosis of prostate cancer (CaP) is controversial. A consensus on the optimal management algorithm of a low risk man with a negative mpMRI is unclear. Current guidelines suggest prostate specific antigen (PSA), digital rectal examination (DRE) and shared decisionmaking should be used to determine if a biopsy should be done. mpMRI has the potential to be used as an additional screening tool to select some men to avoid biopsy, potentially lowering the associated harms and over diagnosis. This study evaluated the outcomes of low risk, mpMRI negative men at our institution. Materials and Methods: Between September 2015 and August 2016, 206 men with a PSA &lt;10 ug/L underwent mpMRI for suspected CaP. 22 men were excluded for: previous TURP, previous MRI, prior biopsy or known CaP. 184 men were evaluated for PSA, MRI findings, Prostate Imaging Reporting and Data System (PI-RADS) score, transrectal ultrasound guided (TRUS) biopsy findings and Gleason scores. Results: 57/184 (31%) of mpMRIs done were thought to have no evidence of CaP (PI-RADS &lt;3). 24/57(42%) of men with a negative MRI went on to have a TRUS biopsy. Of those biopsied, 9/24 (37.5%) were positive and 15/24 (62.5%) were negative for CaP. 6/9 (66.7%) positive biopsies were Gleason 3 + 3 (clinically insignificant CaP). 3/24 (12.5%) of men with a negative MRI had clinically significant CaP, as high as Gleason 4 + 5. Conclusions: Less than half of the men at low risk of prostate cancer (PSA &lt;10 ug/L) that have a negative MRI went on to have a biopsy done. 12.5% of men with a negative mpMRI will have clinically significant CaP. These results indicate that until the performance of mpMRI is improved and definitive surveillance protocols are devised TRUS biopsy continues to play a role in men with negative mpMRIs.&nbsp;[Conference abstract]

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