World J Urol: Predictor Survey of Prostate Cancer When MpMRI is Negative

Since the introduction and widespread use of MRI targets for prostate biopsy, the detection rate of prostate cancer has increased
in the past few years.
Therefore, EAU's prostate cancer guidelines recommend a multiparametric MRI (mpMRI)
prior to a prostate biopsy.

EAU guidelines recommend performing a multiparametric MRI of the prostate (mpMRI) before a biopsy with the goal of improving accuracy and reducing biopsies
.
Whether a biopsy can be avoided in the case of a negative mpMRI remains unclear
.
Researchers from Germany recently published an article in World J Urol evaluating the predictors of prostate cancer (PCa) when mpMRI is negative.

Between 2018 and 2020, researchers conducted telephone interviews with 216 patients suspected of having PCa but negative mpMRI (PI-RADS≤2) for their results and further follow-up
.
Clinically significant PCa (csPCa) is defined as ISUP≥2
.
The researchers also compared patients with or without biopsies with those with or without PCa, and performed univariate and multivariate analyses to assess predictors
of PCa in mpMRI-negative patients.

The results of the study found that 15.
7% and 5.
1% of patients with PI-RAD≤2 had PCa and csPCa
, respectively.
Patients with PCa had higher PSAD (0.
14 vs.
0.
09 ng/ml2; p=0.
001), small prostate volume (50.
5 vs.
74.
0 ml; p=0.
003）
。 Patients who did not have a biopsy after MRI (25%) were older (69 vs.
65.
5 years; p=0.
027), lower PSA (5.
7 vs.
6.
73 ng/ml; p=0.
033) and lower PSA density (0.
09 vs.
0.
1ng/ml2; p=0.
027）
。 Multivariate analysis showed that age (OR 1.
09 [1.
02-1.
16]; p=0.
011), prostate volume (OR 0.
982 [0.
065; 0.
997]; p=0.
027), total PSA level (OR 1.
22 [1.
01-1.
47], p=0.
033), free PSA (OR 0.
431 [0.
177; 0.
927]; p=0.
049) and no PI-RADS lesions and PI-RADS 1-2 lesions (OR 0.
38 [0.
15-0.
91], p = 0.
032) were used as predictors of PCa presence
.

Biopsy after a negative mpMRI result

In summary, biopsy
can be avoided in selected patient populations (mpMRI negative) (higher age, prostate volume and free PSA levels, and lower PSA density) if adequate follow-up care is ensured.
In addition, detailed counseling about the residual risk of undetected prostate cancer should be necessary
.

Original source:

Maximilian Haack， Vanessa Miksch， Zhe Tian et al.
Negative multiparametric magnetic resonance imaging for prostate cancer： further outcome and consequences.
World J Urol.
Nov 2022