Can patients with low suspicion on multi-parametric magnetic resonance imaging of the prostate safely avoid prostate biopsy? A single-institution retrospective cohort analysis

Abstract

Objectives: Elevated prostate-specific antigen (PSA) is the commonest reason for having a prostate biopsy, which remains to date the only intentional means of diagnosing prostate cancer (CaP) Multiparametric magnetic resonance imaging (mpMRI) has emerged as a valuable tool to stratify risk of having clinically significant prostate cancer (csCaP) graded by the Prostate Imaging-Reporting and Data System (PI-RADS) score. The aim of this study is to determine the rate of false negative mpMRI in our patients in identification of CaP, and thus mpMRI’s potential to guide clinical decision to avoid prostate biopsy. Patients & Methods: Analysis of our prospective prostate biopsy database of patients who underwent prostate biopsy between the period of January 2017 and August 2021 was performed. Patients suspicious of CaP with PI-RADS category 1 or 2 on mpMRI with systematic prostate biopsy and a PSA level within 4-20ng/mL were included. Patient characteristics and biopsy results were evaluated using univariate and multivariate regression analysis. Results: 92 cases were identified. Median PSA and PSA density (PSAD) for the cohort were 7.4 ng/mL and 0.155ng/mL2 . 6.5% (6/92) of the patients were diagnosed with CaP, none of them was csCaP. Logistic regression analysis did not identify any statistically significant predictive factors for CaP, including PSA (p=0.058), PSAD<0.15 (p=0.945) and PHI (p=0.299). Conclusion: The false negative rate of mpMRI in predicting csCaP in our locality is very low at 0%. The results suggest patients with PI-RADS category 1 or 2 can consider not having prostate biopsy as a shared clinical decision between the patient and urologist.