Abstract:

Background: the optimal method for radiological diagnosis of prostate cancer (PCa) in planning multifocal biopsy is multiparametric magnetic resonance imaging (mpMRI)

Aim: was to improve the diagnosis of clinically significant PCa (csPCa) in patients with a negative primary biopsy, proceeding from mpMRI findings analysis based on results of the repeated procedure (24 cores) with targeted sampling of suspicious lesions.

Materials and methods: 732 patients were examined, 714 of them had been included in data of analysis. Prostatic mpMRI found suspicious foci with PI-RADS 3-5 in 396/714 (55.5%) patients. Results: The detection of PCa with a Gleason score of >7, PI-RADS 4 and 5 accounted for 65.9% and 80.0%, respectively Diagnostic sensitivity of mpMRI with a PI-RADS >4 in the diagnosis of PCa in patients with suspicious foci (n=396) was 83.6%, specificity - 84.9%; in the whole of 714 patients it was 46.4% and 86.7%, with a Gleason score of >7 - 75.3% and 89.3%, respectively In 73/290 (25.2%) patients with PI-RADS 3-5, PCa was detected in a systematic rather than in targeted biopsy, 17/73 (23.3%) of them having Gleason score >7. In 70/318 (22.0%) patients with PI-RADS 1-2, PCa was detected in systematic biopsy, in 11/70 (15.7%) cases Gleason score being >7.

Conclusion: mpMRI diagnostic accuracy for csPCa in patients with negative primary biopsy making it possible to refrain from repeated biopsy in males with PI-RADS 1-3; if repeated biopsy is necessary, the systematic one may be recommended.

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