PD39-12: A prospective trial of multiparametric magnetic resonance of the prostate use to avoid biopsies in patients with elevated prostate specific antigen and surgical indication for benign prostatic hyperplasia

Marcelo Wroclawski, Lucas Takemura*, Felipe Gushiken, Breno Amaral, Paulo Kayano, Ronaldo Baroni, Bianca Bianco, Arie Carneiro, Gustavo Lemos, Sao Paulo, Brazil

Introduction: Patients with benign prostatic hyperplasia (BPH) may have increased prostate specific antigen (PSA) levels, posing a dilemma as to whether perform a prostate biopsy to rule out a concomitant prostate cancer (PCa) before a surgical procedure. Multiparametric magnetic resonance imaging (mpMRI) has increased the detection of clinically significant PCa and may aid the decision to biopsy patients who are suspicious for PCa. This study aimed to evaluate if mpMRI could safely prescind the prostate biopsy in patients who will undergo a BPH procedure.

Methods: Interim analysis of a prospective study including 84 men with surgical indication due to BPH and concomitantly elevated PSA levels (PSA = 4 ng/ml, or PSA = 2 ng/ml if using 5-alpha-reductase inhibitor). All patients underwent 1.5 Tesla mpMRI prior to transrectal ultrasound (TRUS) biopsy. Additional fragments were obtained with the fusion guided technique in cases where mpMRI identified focal lesions. Biopsy histopathological results were used as the standard of reference. Two scenarios were evaluated: scenario 1, considering mpMRI PIRADS 1 and 2 as negative; and scenario 2, considering PIRADS 1, 2 and 3 as negative. Clinically significant PCa was defined as ISUP = 2.

Results: Median age was 72.5 years (53-86), median PSA was 8.06 ng/ml (2.0-39.87) and median prostatic volume was 119.80 cc (30-342). Scenario 1: mpMRI sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for any PCa on biopsy was 65.2%, 68.8%, 44.1%, 84% and 67.8%. For clinically significant PCa, they were 81.8%, 65.7%, 26.4%, 96% and 67.8%, respectively, for the same measures. Scenario 2: mpMRI sensitivity, specificity, PPV, NPV and accuracy for any PCa on biopsy was 39.1%, 91.8%, 64.2%, 80% and 77.3%. For clinically significant PCa, they were 72.7%, 91.7%, 57.1%, 95.7% and 89.2%, respectively, for the same measures.

Conclusions: Prostate mpMRI may prevent unnecessary biopsies in patients with elevated PSA and surgical indication due to BPH, given its high negative predictive value.

Source of Funding: None