Presented by: Alexander Homer AB
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Introduction

Multiparametric MRI (mpMRI) has become a standard of care  in the evaluation of clinically significant prostate cancer (csPCa). Concerns have been raised regarding the learning curve of radiologists and the subjective nature of interpretation. This study aimed to assess the trends in MRI interpretation and the diagnostic accuracy of MRI fusion biopsy.

Materials

A retrospective analysis was conducted on patients without a history of prostate cancer who underwent a 3T mpMRI and TRUS fusion biopsy at a single center between 2017 and 2020. The presence of csPCa was determined based on Grade Group 2 (GG2) or higher, cancer volume > 0.5 mL, or evidence of extra-prostatic extension. Logistic regression examined temporal trends in csPCa probability, GG2+ disease, positive biopsy in more than 50% of cores, perineural invasion, PIRADS 3, 4, or 5, csPCa among PIRADS 3 and PIRADS 4/5 patients, and the association between PSA density and high-grade (HG) disease in PIRADS 4/5 patients. OLS regression analyzed trends in cancer volume.

Results

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311 subjects met the inclusion criteria. The percentages of PIRADS 3, 4, and 5 findings were 18.3%, 29.9%, and 14.5%, respectively. There were increased odds of detecting PIRADS 4/5 (OR: 1.53, 95% CI: 1.27-1.84), csPCa (OR: 1.40, 95% CI: 1.17-1.68), >50% positive cores (OR: 1.80, 95% CI: 1.44-2.27), and perineural invasion (OR 1.81, 95% CI: 1.30-2.64) year-over-year. Cancer volume increased 0.028 mL per year (SE: 0.0077). csPCa was detected in 17.5%, 46.2%, and 60% of PIRADS 3, 4, and 5 exams, respectively. Odds of finding csPCa in PIRADS 4/5 (OR 1.27, 95% CI: 1.006-1.611) and PIRADS 3 lesions (OR 1.52, 95% CI: 1.26-1.86) significantly increased per year. While odds of finding HG cancer in PIRADS 4/5 lesions did not significantly change, there was an increase in PIRADS 3 lesions (OR 1.42, 95% CI: 1.17-1.74). PSA density >0.15 (OR: 2.31 CI: 1.12-4.84) and log PSA density (OR 1.76, CI: 1.085-3.03) were associated with higher PIRADS 4/5 specificity.

Conclusion

Over time, PIRADS 4/5 findings and csPCa have increased in men undergoing mpMRI, indicating improved radiologist skills and a potential trend towards more aggressive cancer. However, PIRADS 5 had lower than expected rates of significant disease. Assessing the negative predictive value in mpMRI remains challenging as those with normal imaging are often monitored instead of biopsied. Continuous evaluation of MRI accuracy and trends is vital for high-quality risk assessment.

Funding

None

Co-Authors

Rebecca M. Ortiz, BA
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University

Borivoj Golijanin, BS
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Sai Allu, ScB
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University

Natalie Passarelli, BA
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University

Vikas Bhatt, MD
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA

Gyan Pareek, MD
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University

Elias S. Hyams, MD
The Minimally Invasive Urology Institute, The Miriam Hospital, Urology Division, Warren Alpert Medical School of Brown University, Providence, RI, USA