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The influence of prostate-specific antigen density on positive and negative predictive values of multiparametric magnetic resonance imaging to detect Gleason score 7-10 prostate cancer in a repeat biopsy setting.

Accepted version
Peer-reviewed

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Article

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Authors

Hansen, Nienke L 
Koo, Brendan 
Doble, Andrew 
Gnanapragasam, Vincent  ORCID logo  https://orcid.org/0000-0003-4722-4207

Abstract

OBJECTIVES: To evaluate the influence of prostate-specific antigen density (PSAD) on positive (PPV) and negative (NPV) predictive values of multiparametric magnetic resonance imaging (mpMRI) to detect Gleason score ≥7 cancer in a repeat biopsy setting. PATIENTS AND METHODS: Retrospective study of 514 men with previous prostate biopsy showing no or Gleason score 6 cancer. All had mpMRI, graded 1-5 on a Likert scale for cancer suspicion, and subsequent targeted and 24-core systematic image-fusion guided transperineal biopsy in 2013-2015. The NPVs and PPVs of mpMRIs for detecting Gleason score ≥7 cancer were calculated (±95% confidence intervals) for PSAD ≤0.1, 0.1-0.2, ≤0.2 and >0.2 ng/mL/mL, and compared by chi-square test for linear trend. RESULTS: Gleason score ≥7 cancer was detected in 31% of the men. The NPV of Likert 1-2 mpMRI was 0.91 (±0.04) with a PSAD of ≤0.2 ng/mL/mL and 0.71 (±0.16) with a PSAD of >0.2 ng/mL/mL (P = 0.003). For Likert 3 mpMRI, PPV was 0.09 (±0.06) with a PSAD of ≤0.2 ng/mL/mL and 0.44 (±0.19) with a PSAD of >0.2 ng/mL/mL (P = 0.002). PSAD also significantly affected the PPV of Likert 4-5 mpMRI lesions: the PPV was 0.47 (±0.08) with a PSAD of ≤0.2 ng/mL/mL and 0.66 (±0.10) with a PSAD of >0.2 ng/mL/mL (P < 0.001). CONCLUSION: In a repeat biopsy setting, a PSAD of ≤0.2 ng/mL/mL is associated with low detection of Gleason score ≥7 prostate cancer, not only in men with negative mpMRI, but also in men with equivocal imaging. Surveillance, rather than repeat biopsy, may be appropriate for these men. Conversely, biopsies are indicated in men with a high PSAD, even if an mpMRI shows no suspicious lesion, and in men with an mpMRI suspicious for cancer, even if the PSAD is low.

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Keywords

image fusion, magnetic resonance imaging, prostate biopsy, prostate cancer, prostate-specific antigen density, transperineal biopsy, Aged, Biopsy, Needle, Humans, Image-Guided Biopsy, Magnetic Resonance Imaging, Male, Middle Aged, Neoplasm Grading, Predictive Value of Tests, Prostate, Prostate-Specific Antigen, Prostatic Neoplasms, Retrospective Studies

Journal Title

BJU International

Conference Name

Journal ISSN

1464-4096
1464-410X

Volume Title

119

Publisher

Wiley-Blackwell
Sponsorship
Nienke L. Hansen has received a research grant from RWTH Aachen University Hospital (Aachen, Germany). Tristan Barrett acknowledges support from Cancer Research UK, National Institute of Health Research Cambridge Biomedical Research Centre, Cancer Research UK and the Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester and the Cambridge Experimental Cancer Medicine Centre. Christof Kastner acknowledges that he is a lecturer for a 3‐day satellite symposium organised by Siemens Healthcare and MedCom GmbH. The Department of Urology also received sponsorship of various industry for organising Prostate MRI workshops.