IMPROVING PROSTATE CANCER DETECTION IN THE PSA GRAY ZONE: A STUDY ON THE EFFICACY OF MULTIPARAMETRIC MRI
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Keywords
Prostate Cancer, Biopsy, PSA, MpMRI, PI-RADS version
Abstract
OBJECTIVE. To evaluate the efficacy of T2-weighted imaging, dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted imaging (DWI) for detecting prostate cancer in patients with total serum prostate-specific antigen (PSA) levels of 4–10 ng/mL, which is referred to as the “gray zone.” Methods: This prospective study included a total of 108 patients with lower urinary tract symptoms (LUTS) and serum PSA between 4 and 10 ng/mL, without abnormal digital rectal examination (DRE) findings of prostate. PIRADS score (V2) was calculated using multi-parametric magnetic resonance imaging (mp-MRI) before TRUS biopsy of prostate. Relationships among PIRADS score, PSA& presence of carcinoma prostate in TRUS biopsy were statistically analyzed. RESULTS. MpMRI had a sensitivity and specificity of 100% and 84.59 % respectively for overall cancer detection. Whereas, the sensitivity was 100% for clinically significant prostate cancers. The negative and positive predictive values were 85.89% and 78.57%% respectively for overall cancer detection whereas the negative predictive value (NPV) was 72.37 % for clinically significant cancer CONCLUSION. Combined T2-weighted imaging, DWI, and DCE-MRI findings appearto be potentially useful for detecting and managing prostate cancer, even for patients with gray-zone PSA levels.Our result shows that use of MpMRI could have avoided 67.59 % of unnecessary biopsies without missing any of cancers.
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1. Center, M. M., Jemal, A., Lortet-Tieulent, J., et al. (2012). International variation in prostate cancer incidence and mortality rates. European Urology, 61(6), 1079–1092. 2. Morgan, T. M., Palapattu, G. S., Partin, A. W., & Wei, J. T. (2016). Prostate Cancer Tumor Markers. In Campbell-Walsh Urology (11th ed., p. 2569). Philadelphia: Elsevier. 3. Thompson, I. M., Pauler, D. K., Goodman, P. J., et al. (2004). Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter. New England Journal of Medicine, 350, 2239–2246. 4. Catalona, W. J., Smith, D. S., Ratliff, T. L., et al. (1991). Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. New England Journal of Medicine, 324, 1156–1161. 5. Catalona, W. J., Partin, A. W., Slawin, K. M., et al. (1998). Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. Journal of the American Medical Association, 279, 1542–1547. 6. Partin, A. W., Brawer, M. K., Subong, E. N., et al. (1998). Prospective evaluation of percent free-PSA and complexed-PSA for early detection of prostate cancer. Prostate Cancer and Prostatic Diseases, 1(3), 197–203. 7. Hoeks, C. M., Barentsz, J. O., Hambrock, T., et al. (2011). Prostate cancer: multiparametric MR imaging for detection, localization, and staging. Radiology, 261(1), 46–66. 8. Siddiqui, M. M., Rais-Bahrami, S., Turkbey, B., et al. (2015). Comparison of MR/ultrasound fusion–guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. Journal of the American Medical Association, 313(4), 390–397. 9. Barentsz, J. O., Richenberg, J., Clements, R., et al. (2012). ESUR prostate MR guidelines 2012. European Radiology, 22(4), 746–757. 10. Weinreb, J. C., Barentsz, J. O., Choyke, P. L., et al. (2016). PI-RADS Prostate Imaging-Reporting and Data System: 2015, version 2. European Urology, 69(1), 16–40. 11. Woo, S., Suh, C. H., Kim, S. Y., Cho, J. Y., & Kim, S. H. (2017). Diagnostic performance of Prostate Imaging Reporting and Data System Version 2 for detection of prostate cancer: a systematic review and diagnostic meta-analysis. European Urology, 72(2), 177–188. 12. Kumar, R., Nayyar, R., Kumar, V., et al. (2008). Potential of magnetic resonance spectroscopic imaging in predicting absence of prostate cancer in men with serum prostate-specific antigen between 4 and 10 ng/ml: a follow-up study. Urology, 72, 859–863. 13. Tamada, T., Sone, T., Higashi, H., Jo, Y., Yamamoto, A., Kanki, A., & Ito, K. (2011). Prostate Cancer Detection in Patients With Total Serum Prostate-Specific Antigen Levels of 4–10 ng/mL: Diagnostic Efficacy of Diffusion-Weighted Imaging, Dynamic Contrast-Enhanced MRI, and T2-Weighted Imaging. American Journal of Roentgenology, 197(3), 664-670. 14. Rosario, D. J., Lane, J. A., Metcalfe, C., et al. (2012). Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study. BMJ, 344, d7894. 15. Loeb, S., Carter, H. B., Berndt, S. I., Ricker, W., & Schaeffer, E. M. (2011). Complications after prostate biopsy: data from SEER–Medicare. Journal of Urology, 186(6), 1830–1834. 16. Barentsz, J. O., Weinreb, J. C., Verma, S., Thoeny, H. C., Tempany, C. M., Shtern, F., Padhani, A. R., Margolis, D., Macura, K. J., Haider, M. A., Cornud, F., & Choyke, P. L. (2016). Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use. European Urology, 69(1), 41–49. 17. Epstein, J. I., Chan, D. W., Sokoll, L. J., et al. (1998). Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings. Journal of Urology, 160, 2407–2411. 18. Epstein, J. I., Walsh, P. C., Carmichael, M., et al. (1994). Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. JAMA, 271, 368–374. 19. Meng, X., Rosenkrantz, A. B., Mendhiratta, N., Fenstermaker, M., Huang, R., & Wysock, J. S. (2015). Relationship between prebiopsy multiparametric magnetic resonance imaging (MRI), biopsy indication, and MRI-ultrasound fusion-targeted prostate biopsy outcomes. European Urology, 69(4), 512–517. 20. Perdona, S., Di Lorenzo, G., Autorino, R., Buonerba, C., De Sio, M., Setola, S. V., et al. (2013). Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection. Urologic Oncology, 31(6), 761–765. 21. Agnihotri, S., Mittal, R. D., Ahmad, S., Mandhani, A. (2014). Free to total serum prostate-specific antigen ratio in symptomatic men does not help in differentiating benign from malignant disease of the prostate. Indian Journal of Urology, 30(1), 28–32. 22. Lu, A. J., Syed, J. S., Nguyen, K. A., et al. (2017). Negative multiparametric magnetic resonance imaging of the prostate predicts absence of clinically significant prostate cancer on 12-core template prostate biopsy. Urology, 105, 118–122.
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